Aortic Counterpulsation Therapy in Patients with Advanced Heart Failure: Analysis of the TBRIDGE Registry

• Published in: Arquivos brasileiros de cardiologia Vol. 106; no. 1; pp. 26 - 32
• Main Authors: Bezerra, Cristiano Guedes, Adam, Eduardo Leal, Baptista, Mariana Lins, Ciambelli, Giuliano Serafino, Kopel, Liliane, Bernoche, Claudia, Lopes, Leonardo Nicolau Geisler Daud, Macatrão-Costa, Milena Frota, Falcão, Breno de Alencar Araripe, Lage, Silvia Gelas
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Cardiologia - SBC 01-01-2016; Sociedade Brasileira de Cardiologia (SBC)
• Subjects: Adult; Balão Intra-Aórtico; Brazil; CARDIAC & CARDIOVASCULAR SYSTEMS; Cardiomiopatia Chagásica; Cardiomyopathies - complications; Cardiomyopathies - mortality; Chagas Disease - complications; Chagas Disease - mortality; Choque Cardiogênico / mortalidade; Contrapulsação; Echocardiography; Female; Heart Failure - etiology; Heart Failure - mortality; Heart Failure - therapy; Heart Transplantation - adverse effects; Heart Transplantation - mortality; Hemodynamics; Humans; Insuficiência Cardíaca; Intra-Aortic Balloon Pumping - methods; Male; Middle Aged; Myocardial Ischemia - complications; Myocardial Ischemia - mortality; Original; Prospective Studies; Registries - statistics & numerical data; Risk Factors; Survival Rate; Time Factors; Transplante de Coração; Treatment Outcome; Counterpulsation; Chagas Cardiomyopathy; Heart Transplanation; Choque Cardiogênico / mortalidade; Insuficiência Cardíaca; Cardiomiopatia Chagásica; Heart Failure; Intra-Aortic Balloon Pump; Shock, Cardiogenic / mortality; Transplante de Coração; Balão Intra-Aórtico; Contrapulsação
• ISSN: 0066-782X; 1678-4170; 1678-4170
• DOI: 10.5935/abc.20150147

The use of aortic counterpulsation therapy in advanced heart failure is controversial.
To evaluate the hemodynamic and metabolic effects of intra-aortic balloon pump (IABP) and its impact on 30-day mortality in patients with heart failure.
Historical prospective, unicentric study to evaluate all patients treated with IABP between August/2008 and July/2013, included in an institutional registry named TBRIDGE (The Brazilian Registry of Intra-aortic balloon pump in Decompensated heart failure - Global Evaluation). We analyzed changes in oxygen central venous saturation (ScvO2), arterial lactate, and use of vasoactive drugs at 48 hours after IABP insertion. The 30-day mortality was estimated by the Kaplan-Meier method and differences in subgroups were evaluated by the Log-rank test.
A total of 223 patients (mean age 49 ± 14 years) were included. Mean left ventricle ejection fraction was 24 ± 10%, and 30% of patients had Chagas disease. Compared with pre-IABP insertion, we observed an increase in ScvO2 (50.5% vs. 65.5%, p < 0.001) and use of nitroprusside (33.6% vs. 47.5%, p < 0.001), and a decrease in lactate levels (31.4 vs. 16.7 mg/dL, p < 0.001) and use of vasopressors (36.3% vs. 25.6%, p = 0.003) after IABP insertion. Thirty-day survival was 69%, with lower mortality in Chagas disease patients compared without the disease (p = 0.008).
After 48 hours of use, IABP promoted changes in the use of vasoactive drugs, improved tissue perfusion. Chagas etiology was associated with lower 30-day mortality. Aortic counterpulsation therapy is an effective method of circulatory support for patients waiting for heart transplantation.