Impact of Intra-aortic Balloon Pump in Advanced Heart Failure and Cardiogenic Shock Pre and Post Heart Transplant

The use of the intra-aortic balloon pump (IABP) in advanced heart failure (HF) and cardiogenic shock (CS) is still under debate. In this study we sought to assess the clinical and hemodynamic outcomes in IABP-treated heart transplantation (HTx) patients as well as its impact on mortality. We retrospectively analyzed patients with advanced HF and CS, admitted in the cardiac intensive care unit (ICU) of our institution, between 2009 and 2020, who underwent HTx. We compared patients treated with IABP pre-HTx with a control (CR) group submitted to HTx without mechanical circulatory support. Propensity Score Matching was used to pair the groups according to relevant clinical covariates. 326 patients were included (IABP= 199; CR= 127). Overall survival was similar in IABP and CR groups at 30 days post-HTx (p=0.459). Clinical conditions improved 96 hours after IABP therapy. Central venous oxygen saturation (ScvO2) increased from 49.9% to 66.85% (p<0.001), and diuresis from 1690.12 mL/24 h to 2193.12 mL/24h (p<0.001). Lactate decreased from 21.91 mg/dl to 12.6 mg/dl (p<0.001) and creatinine from 2.04 mg/dL to 1.72 mg/dL (p=0.301). The use of nitroprusside increased from 58.08 to 63.59% (p=0.154), and norepinephrine decreased from 17.7% to 6.63% (p<0.001). The differences were maintained until HTx. IABP related complications were few. Overall outcomes of IABP in advanced HF and CS as a bridge therapy to HTx are encouraging. The survival rate was similar between the groups and IABP can be considered a safe and effective device with few and manageable complications.