Long-Term Intra-Aortic Balloon Pump Support as Bridge to Left Ventricular Assist Device Implantation

The intra-aortic balloon pump (IABP) can be used to bridge critically ill end-stage heart failure patients to left ventricular assist device (LVAD) implantation. However, the IABP's potential association with hemorrhagic complications raises concerns regarding its utilization in these patients.

We investigated whether preoperative long-term IABP support increases hemorrhagic complications post-LVAD implantation.

Ten patients undergoing IABP support prior to LVAD implantation (IABP-LVAD group) were compared with 16 who did not require IABP support (LVAD group).

Mean duration of IABP support was 25.8 days. Preoperatively, both groups were comparable in all measured parameters and indices of end-organ function. Perioperative (defined as three weeks post-LVAD implantation, including the procedure) cellular and noncellular blood transfusion requirements were similar between IABP-LVAD and LVAD groups (19.8 ± 9.95 vs. 19.76 ± 29.69 RBC units, p = 0.96; 3.8 ± 4.14 vs. 2.0 ± 6.44 plateletpheresis units p = 0.84; 23 ± 16.04 vs. 25.14 ± 37.8 fresh frozen plasma units, p = 0.45). Perioperative minimum hematocrit (33.6 ± 5.6 vs. 36.59 ± 4.8, p = 0.38) and minimum platelet count (199 ± 153 vs. 144 ± 65, p = 0.52) were similar in the two groups. Two patients in the IABP-LVAD group and three patients in the LVAD group underwent reoperation post-LVAD implantation for bleeding. Length of ICU stay was longer in the LVAD group but did not reach statistical significance (6.2 ± 6.22 days in the IABP-LVAD group versus 13.45 ± 10.95 days in the LVAD group, p = 0.06).

Long-term IABP support as a bridge to LVAD implantation is not associated with increased hemorrhagic complications post-LVAD implantation. doi: 10.1111/jocs.12759 (J Card Surg 2016;31:467-471).