TY - JOUR
T1 - Cardiogenic shock in the setting of severe aortic stenosis
T2 - Role of intra-aortic balloon pump support
AU - Aksoy, Olcay
AU - Yousefzai, Rayan
AU - Singh, Dhssraj
AU - Agarwal, Shikhar
AU - O'Brien, Bridget
AU - Griffin, Brian P.
AU - Kapadia, Samir R.
AU - Tuzcu, Murat E.
AU - Penn, Marc S.
AU - Nissen, Steven E.
AU - Menon, Venu
PY - 2011/5
Y1 - 2011/5
N2 - 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 years). The peak and mean Doppler AV gradients were 67±26.8 mm Hg and 39.8±16.8 mm Hg, respectively, with a mean baseline cardiac index of 1.77±0.38 l/min/m2). 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/m2 to 2.18 and 2.36 l/min/m 2 at 6 and 24 h, respectively (p<0.001 for both times points). Systemic vascular resistance was reduced from 1331 dyn/s/cm5 to 1265 and 1051 dyn/s/cm5 at 6 and 24 h, respectively (p=0.66 and p=0.005, respectively). The central venous pressure was reduced from 14.8 mm Hg to 13.2 and 10.9 mm Hg at 6 and 24 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.
AB - 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 years). The peak and mean Doppler AV gradients were 67±26.8 mm Hg and 39.8±16.8 mm Hg, respectively, with a mean baseline cardiac index of 1.77±0.38 l/min/m2). 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/m2 to 2.18 and 2.36 l/min/m 2 at 6 and 24 h, respectively (p<0.001 for both times points). Systemic vascular resistance was reduced from 1331 dyn/s/cm5 to 1265 and 1051 dyn/s/cm5 at 6 and 24 h, respectively (p=0.66 and p=0.005, respectively). The central venous pressure was reduced from 14.8 mm Hg to 13.2 and 10.9 mm Hg at 6 and 24 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.
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U2 - 10.1136/hrt.2010.206367
DO - 10.1136/hrt.2010.206367
M3 - Article
C2 - 20962337
AN - SCOPUS:79955147775
SN - 1355-6037
VL - 97
SP - 838
EP - 843
JO - Heart
JF - Heart
IS - 10
ER -