Abstract 12588: Intra-Aortic Balloon Pump versus Peripheral Left Ventricular Assist Device in Cardiogenic Shock: A Meta-Analysis of Randomized Control Trials - Same Effect, Less Complications
Background: Despite medical advances cardiogenic shock is still carries an ominous prognosis. Intra-aortic Baloon Pump (IABP) has been established as an adjuvant therapy with limited efficacy. The new per cutaneous Left Ventricular Assist Device (pLVAD) such as the Impella and the Tandem Heart are promising due to a possible improvement in the hemodynamic support and in the unloading of the heart.
Methods: We searched PubMed, EMBASE, and Cochrane databases from 1966 through May 2013 for randomized controlled trials utilizing IABP and pLVADs on cardiogenic shock. We compared IABP and pLVADs 30 days mortality, limb ischemia, and major bleeding. We analyzed the data with RevMan 5.2 using fixed effect if P>0.1 and I2≤40% and random effect otherwise.
Results: Out of initial 90 articles, three studies presented the studied data and were included in the analysis. The pooled data provided a total of 100 patients being 47 on IABP and 53 on pLVAD. As demonstrated in Figure 1, IABP and pLVADs had 30 similar mortality (A) but pLVADs were inferior to IABP regarding morbidities as they had a 4 fold increase in limb ischemia (B) and an 8 fold increase in major bleeding (C).
Conclusion: In our study we found IABP as efficacious and with fewer complications when compared with pLVADs for cardiogenic shock supporting the concept that a newer technology has to be proven before abandoning the prior one. Despite the small population all studies pointed to the same facts. Larger randomized controlled trials are necessary.
- Cardiovascular disease
- Ventricular assist devices
- Interventional cardiology
- Heart catheterization
- © 2013 by American Heart Association, Inc.