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Updated: Jul 6, 2025
The Intra-Aortic Balloon Pump
Published on: February 5, 2021
Hemodynamic effects of larger volume intra-aortic balloon pump during high-risk percutaneous coronary interventions
Aleksander Zeliaś1,2, Wojciech Zajdel3, Krzysztof Malinowski4,5
1The Faculty of Medicine and Health Sciences, University of Applied Sciences in Nowy Sacz, Nowy Sącz, Poland. a.zelias@intercard.net.pl.
Insights
Larger volume intra-aortic balloon pumps (IABP) significantly improved cardiac output and power in high-risk patients undergoing PCI compared to standard IABP or no support. This suggests larger IABP may offer better hemodynamic support during these procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- High-risk percutaneous coronary intervention (HRPCI) carries an elevated risk of complications.
- Mechanical circulatory support, such as intra-aortic balloon pumps (IABP), can mitigate procedural risks.
Purpose of the Study:
- To compare the hemodynamic effects of larger volume (MEGA) versus standard volume (STRD) IABP during HRPCI.
- To evaluate these effects against a control group (CTRL) receiving no mechanical support.
Main Methods:
- A single-center, open-label randomized controlled trial involving 47 HRPCI patients.
- Patients were assigned to MEGA, STRD, or CTRL groups (1:1:1 ratio).
- Hemodynamic parameters including cardiac output, cardiac power output (CPO), pulmonary artery wedge pressure (PCWP), and left ventricle systolic pressure (LVSP) were analyzed.
Main Results:
- MEGA IABP significantly increased cardiac output and CPO compared to CTRL; STRD did not show this effect.
- Both MEGA and STRD IABP groups demonstrated significant increases in endocardial viability ratio (EVR) and decreases in LVSP versus CTRL.
- Higher diastolic augmented pressure was observed with MEGA IABP, correlating with improved systolic unloading.
Conclusions:
- Larger volume IABP devices demonstrate superior hemodynamic benefits compared to standard volume IABP during HRPCI.
- These findings suggest that MEGA IABP may provide enhanced support for high-risk patients undergoing complex coronary interventions.
Background:
Percutaneous coronary intervention in high-risk patients (HRPCI) is associated with increased risk of complications. Mechanical circulatory support devices, including intra-aortic balloon pump (IABP) may bridge patient safely throughout the procedure.
Aim:
We aimed to describe hemodynamic effects of larger (MEGA) compared to standard (STRD) volume IABP or no balloon control group (CTRL) during HRPCI.
Methods:
In this single-center, open-label randomized controlled trial HRPCI were randomly assigned to three groups according to planned hemodynamic support: MEGA, STDR and CTRL in a 1:1:1 scheme. Screening failure patients formed registry (REG). We analyzed data from pulmonary artery catheter especially cardiac output and cardiac power output (CPO) with Fick method and pulmonary artery wedge pressure (PCWP), as well as left ventricle systolic pressure (LVSP) with PIGTAIL catheter. We also calculated endocardial viability ratio (EVR) and analyzed pressure tracings from the IABP console. We compared baseline and on-support values. Final hemodynamic analysis was done on per-treatment basis, including REG patients.
Results:
A total of 47 patients were analyzed (16 MEGA, 10 STRD and 21 CTRL). Compared to CTRL we found significant increase from baseline to on-support value for cardiac output and CPO in the MEGA, but not in the STRD group. The change in EVR (increase) and in LVSP (decrease) was significant equally in MEGA and STRD vs. CTRL group, but PCWP did not change significantly for both balloons vs. CTRL. Diastolic augmented pressure with IABP was higher in MEGA than STRD and was positively correlated with systolic unloading.
Conclusions:
We observed more favorable hemodynamic effects of larger compared to standard volume balloon.
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