[Counterpulsation balloon and ventricular support]

There are a number of conditions that give rise to or result from a failing heart and that require assisting or replacing the insufficient or abnormal ventricular function. In addition, in attempting to treat these conditions medically or surgically, a wide range of mechanical assisted ventricular devices has been developed, which can potentially address these conditions. Balloon counterpulsation was first employed clinically in 1968 by Kantrowitz. The increased coronary perfusion that results from Intraaortic Balloon Pump (IABP) inflation during diastole and the decreased afterload and enhanced cardiac output from IABP deflation during systole is theoretically the ideal therapy for cardiogenic shock, in which the cardiac output is low and the systemic vascular resistance high. The most obvious efficacy, both theoretically and empirically, is in the setting of ischemia resulting from coronary artery disease. Likewise, the IABP provides an effective and safe form of mechanical support in many high-risk patients undergoing coronary angioplasty. Contraindications for IABP use include aortic valve insufficiency and aortic dissection. Reported complication rates vary, but are probably in the range of 5-10%. Most incidents are related to thromboembolism, uncommonly related to arterial trauma and limb ischemia.