30 years clinical intra-aortic balloon pumping: Facts and figures

Since its first clinical application 30 years ago, intra-aortic balloon pum ping (IABP) has become the most widely applied mechanical circulatory assis t method. Following dissappointing initial results in patients with cardiog enic shock after acute myocardial infarction, IABP has been preferentially used for treatment of post cardiac surgery low output syndrome. However, in recent years IABP use appears to be changing mainly due to increased use i n the setting of acute myocardial ischemia/infarction associated with inter ventional cardiology, as well as trends for both overall increasing periope rative IABP use and relatively increasing preoperative use in high risk pat ients undergoing cardiac surgery. Despite the superiority of ventricular as sist devices (VADs) in terms of circulatory support, IABP remains the clini cian's first choice in postcardiotomy low output syndrome either alone or i n combination with VAD's. Although IABP-related mortality and complication rate are declining in recent years, it has to be emphasized that IABP is st ill associated with substantial mortality and morbidity. However, the avail able data suggest that early IABP use significantly reduces mortality and m orbidity in both cardiac surgery and cardiology patients. In addition, stud ies have shown that aggressive IABP use is "cost-effective" at least in sel ected patients due to both shorter hospital stay and complication reduction . Thus, the available 30 years experience appears to justify a more liberal IABP use in both cardiac surgery and cardiology.