INTRAAORTIC BALLOON PUMPING FOR CARDIAC SUPPORT - TRENDS IN PRACTICE AND OUTCOME, 1968 TO 1995

Objectives: A total of 4756 cases of intraaortic balloon pump support have been recorded at the Massachusetts General Hospital since the fir st clinical insertion for cardiogenic shock in 1968. This report descr ibes the patterns of intraaortic balloon use and associated outcomes o ver this time period. Methods: A retrospective record review was condu cted. Results: Balloon use has increased to more than 300 cases a year at present. The practice of balloon placement for control of ischemia (2453 cases, 11.9% mortality) has become more frequent, whereas suppo rt for hemodynamic decompensation (congestive heart failure, hypotensi on, cardiogenic shock) has been relatively constant (1760 cases, 38.2% mortality). Mean patient age has increased from 54 to 66 years, and m ortality has fallen from 41% to 20%. Sixty-five percent (3097/4756) of the total patient population receiving balloon support underwent card iac surgery. Placement before the operation (2038 patients) was associ ated with a lower mortality (13.6%) than intraoperative (771 patients, 35.7% mortality) or postoperative use (276 patients, 35.9% mortality) . Independent predictors of death with balloon pump support were inser tion in the operating room or intensive care unit, transthoracic inser tion, age, procedure other than angioplasty or coronary artery bypass, and insertion for cardiogenic shock. Independent predictors of death with intraoperative balloon insertion were age, mitral valve replaceme nt, prolonged cardiopulmonary bypass, urgent or emergency operation, p reoperative renal dysfunction, complex ventricular ectopy, right ventr icular failure, and emergency reinstitution of cardiopulmonary bypass. Conclusions: Balloons are being used more frequently for control of i schemia in more patients who are elderly with lower mortality. An inst itutional bias toward preoperative use of the balloon pump appears to be associated with improved outcomes.