ROLE OF INTRAAORTIC BALLOON PUMP COUNTERPULSATION IN HIGH-RISK CORONARY ROTATIONAL ATHERECTOMY

Objectives. This study sought to evaluate the role of intraaortic ball oon pump counterpulsation in preventing hemodynamic in stability and p romoting a successful outcome during percutaneous transluminal coronar y rotational atherectomy in high risk patients. Background. The applic ation of rotational atherectomy has widened to include patients with c omplex lesions and left ventricular dysfunction. Although intraaortic balloon pumping has been successfully used to provide hemodynamic supp ort during balloon angioplasty, its role in high risk rotational ather ectomy has not yet been defined. Methods. In a retrospective review of 159 consecutive high risk patients who underwent rotational atherecto my, 28 had an intraaortic balloon pump placed electively before the pr ocedure (Group 1) whereas 131 did not (Group 2). Results. Group 1 was older and more likely to have multivessel disease and left ventricular dysfunction. Augmented diastolic pressure was maintained > 90 mm Hg i n all Group 1 patients, and significant procedure related hypotension, vas encountered in nine Group 2 patients, requiring an emergency intra aortic balloon pump in five. Procedural success,vas achieved in all 28 patients in Group 1 and in 118 in Group 2 (p = 0.07). Slow flow occur red in 18% and 17% of Group 1 and 2 patients, respectively. Among pati ents with slow flow, non-Q wave myocardial infarction occurred only in Group 2 (0% vs. 27%). On multivariate analysis, elective intraaortic balloon pump placement was the only variable to correlate with a succe ssful procedure uncomplicated by hypotension (p < 0.05). Hospital stay and vascular complications were similar in both groups. Conclusions. Elective placement of an intraaortic balloon pump before coronary rota tional atherectomy in selected high risk patients promotes both proced ural hemodynamic stability and a successful outcome.