Intra-Aortic Balloon Pump Use Before Left Ventricular Assist Device Implantation: Insights From the INTERMACS Registry.

Published

Journal Article

Use of durable, continuous-flow left ventricular assist devices (LVADs) has expanded rapidly, although data are limited regarding optimization strategies before LVAD implantation. We examined current use of intra-aortic balloon pumps (IABPs) before LVAD implantation and compared outcomes of patients with IABP use to those without. We analyzed data from the Interagency Registry for Mechanical Assisted Circulatory Support (INTERMACS) on patients who underwent LVAD implantation between 2006 and 2014. We limited the analysis to patients with an admitting diagnosis of LVAD placement. The primary exposure was IABP use within 48 hours before LVAD implantation. We used propensity scores to compare 30 day postoperative outcomes to reduce treatment selection bias. Of 2,446 patients, 433 (18%) received an IABP before LVAD placement. Patients with IABP use, compared with those without, had markers of more advanced disease, including worse renal and liver function, worse right ventricular function, and use of mechanical ventilation (p < 0.05 for all comparisons). A composite outcome of post-operative right heart failure, hepatic dysfunction, renal dysfunction, or death occurred in 83 (19.2%) patients with IABP use, compared with 342 (17.1%) patients without IABP use (unadjusted hazard ratio, 1.13; 95% confidence interval, 0.89-1.44; adjusted hazard ratio, 1.02; 95% confidence interval, 0.78-1.33). IABP use before LVAD placement was common. Despite markers of higher risk in patients with IABP use, we found no significant difference in 30 day outcomes compared to those without. The results suggest that IABP use may mitigate risk of early postoperative adverse outcomes in select patients.

Full Text

Duke Authors

Cited Authors

  • DeVore, AD; Hammill, BG; Patel, CB; Patel, MR; Rogers, JG; Milano, CA; Hernandez, AF

Published In

Volume / Issue

  • 64 / 2

Start / End Page

  • 218 - 224

PubMed ID

  • 29470245

Pubmed Central ID

  • 29470245

Electronic International Standard Serial Number (EISSN)

  • 1538-943X

Digital Object Identifier (DOI)

  • 10.1097/MAT.0000000000000629

Language

  • eng

Conference Location

  • United States