Document Detail


Cardiogenic shock in the setting of severe aortic stenosis: role of intra-aortic balloon pump support.
MedLine Citation:
PMID:  20962337     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Objective To investigate the haemodynamic effects of intra-aortic balloon pump (IABP) support in patients with severe aortic stenosis (AS) presenting in cardiogenic shock (CS). Design Observational cohort study. Setting Tertiary academic centre coronary intensive care unit (CICU). Patients Patients presenting to the CICU in CS with an established diagnosis of AS (n=25 with mean age (±SD) of 73.5±9.5&emsp14;years). The peak and mean Doppler AV gradients were 67±26.8&emsp14;mm Hg and 39.8±16.8&emsp14;mm Hg, respectively, with a mean baseline cardiac index of 1.77±0.38&emsp14;l/min/m(2)). Interventions Utilisation of IABP. Main outcome measures Haemodynamic impact of IABP over time. Results With the insertion of an IABP, patients' cardiac index improved from 1.77 l/min/m(2) to 2.18 and 2.36 l/min/m(2) at 6 and 24&emsp14;h, respectively (p<0.001 for both times points). Systemic vascular resistance was reduced from 1331 dyn/s/cm(5) to 1265 and 1051 dyn/s/cm(5) at 6 and 24&emsp14;h, respectively (p=0.66 and p=0.005, respectively). The central venous pressure was reduced from 14.8&emsp14;mm Hg to 13.2 and 10.9&emsp14;mm Hg at 6 and 24&emsp14;h, respectively (p=0.12 and p=0.03, respectively). IABP insertion was associated with a complication in 3 of the 25 cases, including a deep vein thrombosis, thrombocytopenia, limb ischaemia, and technical malfunctioning of the device. Conclusions IABP support improves the haemodynamic profile in patients with severe AS who present in CS. IABP utilisation in this critically ill population should be strongly considered as patients are being evaluated for candidacy for advanced interventions.
Authors:
Olcay Aksoy; Rayan Yousefzai; Dhssraj Singh; Shikhar Agarwal; Bridget O'Brien; Brian P Griffin; Samir R Kapadia; Murat E Tuzcu; Marc S Penn; Steven E Nissen; Venu Menon
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Publication Detail:
Type:  Journal Article     Date:  2010-10-20
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  97     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-04-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  838-43     Citation Subset:  AIM; IM    
Affiliation:
Director Coronary Intensive Care Unit, Cleveland Clinic, 9500 Euclid Avenue/J1-5, Cleveland, Ohio 44195, USA; menonv@ccf.org.
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