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      Intraaortic balloon pump support during coronary angioplasty. Initial experience

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          Abstract

          OBJECTIVE: To evaluate the use of the intraaortic balloon (IAoB) in association with coronary angioplasty in high-risk patients. METHODS: Fourteen high-risk patients unresponsive to clinical therapy and with formal contraindication to surgical revascularization were treated by coronary angioplasty, most of which was followed by stenting. All procedures were performed with circulatory support with the IAoB. This study reports the early results and the late findings after 12 months of follow-up. Six patients had multivessel coronary disease; of these, four had left main equivalent lesions and two had unprotected left main coronary artery disease, one of whom had severe "end-vessel" stenosis and the other was a patient with Chagas' disease with single-vessel lesion. Eleven patients had a left ventricular ejection fraction <30%. RESULTS: In 100% of the patients, the procedures were initially successful. Two patients had severe bleeding during the withdrawal of the left femoral sheath. At the end of twelve months, 4 patients were asymptomatic and the others were clinically controlled. There were two late deaths in the 7th and 11th months. CONCLUSION: The combined use of the intraaortic balloon pump and percutaneous coronary angioplasty in high-risk patients with acute ischemic syndromes provides the necessary hemodynamic stability to successfully perform the procedures.

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          Most cited references36

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          Angiographic and clinical predictors of acute closure after native vessel coronary angioplasty.

          To determine predictors of acute coronary closure after PTCA performed with steerable catheter systems, we compared 140 procedures complicated by acute closure and 311 representative successful attempts from 4,772 procedures performed between April 1982 and March 1986. Sixteen clinical, 35 angiographic, and seven procedural variables were analyzed. Multivariate analysis found seven independent preprocedural factors related to closure: stenosis length of 2 or more luminal diameters, female gender, stenosis at a bend point of 45 degrees or more, stenosis at a branch point, stenosis-associated thrombus (filling defect or staining), other stenoses in the same vessel, and multivessel disease. In addition, four procedural factors were found to be associated with closure by univariate analysis: post-PTCA percent stenosis (p less than .001), intimal tear or dissection (p less than .001), use of prolonged heparin infusion (p less than .001), and post-PTCA gradient of 20 mm Hg or more (p = .004). Multivariate analysis of both preprocedural and procedural variables found six factors independently related to closure: post-PTCA percent stenosis, dissection, prolonged post-PTCA use of heparin, branch point location, fixed bend point location, and other stenoses in the vessel dilated. The risk of coronary closure after PTCA has many determinants. While an estimation of risk can be made before performing PTCA, the most powerful predictors of closure can only be assessed during the procedure itself.
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            Initial clinical experience with intraaortic balloon pumping in cardiogenic shock.

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              Randomized controlled trial of intraaortic balloon counterpulsation in early myocardial infarction with acute heart failure.

              The value of intraaortic balloon counterpulsation in limiting infarct size and improving survival was studied in patients with early transmural myocardial infarction complicated by acute heart failure. Thirty such patients, previously well, were randomly assigned to counterpulsation (14 patients) or standard therapy (16 patients). Counterpulsation was begun 4.8 to 13.7 hours (mean 7.1) after the onset of pain and continued for less than 1 to 11 days (mean 4.5). Peak creatine kinase was 1,794 +/- 846 IU/liter (mean +/- standard deviation) in patients receiving counterpulsation compared with 1,688 +/- 908 for those receiving standard therapy; cumulative creatine kinase was 3,590 +/- 1,936 IU/liter for patients receiving counterpulsation and 2,945 +/- 1,803 for those receiving standard therapy. Hospital mortality was similar (counterpulsation, 7 of 14; standard therapy, 7 of 16 [p = 0.05 for 25 percent mortality reduction]) as was mortality at follow-up (counterpulsation, 8 of 14; standard therapy, 10 of 16 [p = 0.09 for 25 percent mortality reduction]). Functional class at follow-up examination 1 to 36 months (mean 15) after infarction was also similar in the two groups. Counterpulsation did not appear to modify infarct size or to alter morbidity or mortality when initiated as primary therapy 4.8 to 13.7 hours after the onset of symptoms of myocardial infarction.
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                Author and article information

                Journal
                abc
                Arquivos Brasileiros de Cardiologia
                Arq. Bras. Cardiol.
                Sociedade Brasileira de Cardiologia - SBC (São Paulo, SP, Brazil )
                0066-782X
                1678-4170
                August 1999
                : 73
                : 2
                : 191-200
                Affiliations
                [01] Brasília orgnameHospital das Forças Armadas
                Article
                S0066-782X1999000800007 S0066-782X(99)07300207
                10.1590/S0066-782X1999000800007
                34673bd7-fb1c-46a2-9b1a-f2b7cad17a90

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 28 October 1998
                : 04 July 1999
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 28, Pages: 10
                Product

                SciELO Brazil

                Self URI: Full text available only in PDF format (EN)
                Categories
                Original Articles

                intraaortic balloon pump,circulatory support,coronary angioplasty

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