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IABP implantation as a non-pharmacological treatment of heart failure-related cardiogenic shock: hemodynamic trajectory and clinical outcomes
Session:
Sessão de Posters 50 - Terapêuticas avançadas na insuficiência cardíaca e em populações especiais
Speaker:
Maria Inês Vicente Soares
Congress:
CPC 2026
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.6 Acute Heart Failure - Clinical
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Maria Inês Vicente Soares; Rita Almeida Carvalho; Raquel Montalvão; Margarida Matias; Ana Rita Bello; João Presume; Jorge Ferreira; Catarina Brízido
Abstract
<p>Introduction: Intra-aortic balloon pump (IABP) remains a widely available and easily deployable form of temporary mechanical circulatory support (MCS) for patients in cardiogenic shock (CS). While large randomized trials in myocardial infarction–related shock failed to demonstrate a survival benefit, emerging evidence suggests that in heart failure–related cardiogenic shock (HF-CS) IABP may provide rapid hemodynamic stabilization, improve tissue perfusion, and serve as a bridge to CS recovery or advanced HF therapies. We aimed to evaluate clinical and hemodynamic response to IABP implantation in HF-CS patients. <br /> <br /> Methods: Retrospective analysis of consecutive patients admitted to a cardiac intensive care unit (CICU) between 2022–2025, who underwent IABP insertion for HF-CS. Clinical and laboratorial variables, as well as vasoactive support immediately before IABP insertion, and at 24 and 48 hours, were compared using independent samples T-test. Patients who recovered from CS or were successfully bridged to advanced HF therapies without additional MCS devices were considered IABP responders. <br /> <br /> Results: The cohort comprised 13 patients with a mean age of 58±18 years; 92% (n = 12) were male, 46% (n = 6) had chronic HF, 23% (n = 3) had an implantable cardioverter-defibrillator (ICD), and 7.7% (n = 1) had peripheral arterial disease. At admission, SCAI class distribution was B 7.7% (n = 1), C 77% (n = 10), and D 15% (n = 2). All IABPs were inserted uneventfully, and all but one were inserted at the bedside on the CICU. <br /> <br /> After IABP implantation, mean arterial pressure (MAP) remained stable from 75 mmHg [63–83] to 70 mmHg [64–80] at 24h (p = 0.70), but increased to 83 mmHg [72–90] at 48h (p = 0.10). Lactate decreased from 2,1 [1,65–4,8] to 1,1 [0,85–1,8] at 24h (p=0,002) and remained stable at 48h 0.95 mmol/L [0.8–1.23] (p=0,003), while central venous oxygen saturation increased from 50% [33–61] to 60.5% [56–68] at 24h (p = 0.021) and 69% [55–74.5] at 48h (p = 0.012). NTproBNP levels also decreased from 13,947 pg/mL [3887–27286] to 8,909 pg/mL [3220–20335] at 24 hours (p = 0.075) and 4,241 pg/mL [956–7358] at 48 hours (p = 0.004). Concomitantly, vasoactive requirements decreased: norepinephrine doses were reduced from 0.59 µg/kg/min [0.14–0.89] to 0.33 µg/kg/min [0.14–0.60] at 24h (p = 0.043) and 0.16 µg/kg/min [0.02–0.25] at 48h (p = 0.028). </p> <p>Eleven patients (85%) were classified as IABP responders and were successfully bridged to either CS recovery (n = 7), left ventricular assist device implantation (n = 2), or heart transplantation (n = 2). IABP support failed to stabilize two patients (15%), who required MCS escalation to VA-ECMO. <br /> <br /> Conclusions: IABP use in HF-CS led to a rapid improvement in hemodynamic and laboratorial parameters, also reflected by reduced vasoactive support requirements. Most patients were IABP responders, highlighting the value of this adjunctive therapy for HF-CS patients.</p>
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