Cardiogenic shock in the setting of severe aortic stenosis: Role of intra-aortic balloon pump support

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.