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

Since its first clinical application 30 years ago, intra-aortic balloon pumping (IABP) has become the most widely applied mechanical circulatory assist method. Following disappointing initial results in patients with cardiogenic 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 in the setting of acute myocardial ischemia/infarction associated with interventional cardiology, as well as trends for both overall increasing perioperative IABP use and relatively increasing preoperative use in high risk patients undergoing cardiac surgery. Despite the superiority of ventricular assist devices (VADs) in terms of circulatory support, IABP remains the clinician's first choice in postcardiotomy low output syndrome either alone or in combination with VAD's. Although IABP-related mortality and complication rate are declining in recent years, it has to be emphasized that IABP is still associated with substantial mortality and morbidity. However, the available data suggest that early IABP use significantly reduces mortality and morbidity in both cardiac surgery and cardiology patients. In addition, studies have shown that aggressive IABP use is "cost-effective" at least in selected 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.