From the Guidelines
Refractory ventricular failure is not a contraindication to IABP therapy, but rather an indication for its use. In fact, IABP works by increasing coronary perfusion during diastole and reducing afterload during systole, which helps support the failing ventricle by improving myocardial oxygen supply and decreasing myocardial oxygen demand, as noted in the study by 1. This makes it particularly useful in cases of refractory ventricular failure when other interventions have been unsuccessful.
The other options—severe aortic valvular insufficiency, abdominal or aortic aneurysm, and iliac arterial disease—are all true contraindications to IABP therapy. Aortic insufficiency would worsen with IABP due to increased regurgitation during diastolic augmentation, as mentioned in the study by 1, while aneurysms and iliac disease present risks of vascular complications during insertion and operation of the device. According to the study by 1, IABC is contraindicated in patients with aortic dissection or significant aortic insufficiency, and it should not be used in patients with severe peripheral vascular disease.
Some key points to consider when evaluating the use of IABP therapy include:
- The patient's underlying cardiac condition and potential for recovery or correction with IABP support
- The presence of any contraindications, such as severe aortic insufficiency or peripheral vascular disease
- The potential benefits of IABP in improving myocardial oxygen supply and decreasing myocardial oxygen demand, as noted in the study by 1. Overall, the decision to use IABP therapy should be based on a careful evaluation of the patient's individual needs and circumstances, with consideration of the potential benefits and risks, as discussed in the studies by 1 and 1.
From the Research
Contraindications to IABP Therapy
The following are contraindications to Intra-Aortic Balloon Pump (IABP) therapy:
- Severe aortic valvular insufficiency
- Abdominal or aortic aneurysm
- Iliac arterial disease
Exception to Contraindications
Refractory ventricular failure is not a contraindication to IABP therapy. In fact, studies have shown that IABP can be an effective means of controlling refractory ventricular arrhythmia, allowing time for the institution of more definitive treatment 2. Additionally, IABP has been used to support patients with advanced heart failure, including those with refractory ventricular failure, as a bridge to transplantation or other definitive therapies 3, 4, 5.
Key Points
- IABP therapy can be used to support patients with advanced heart failure, including those with refractory ventricular failure
- Severe aortic valvular insufficiency, abdominal or aortic aneurysm, and iliac arterial disease are contraindications to IABP therapy
- Refractory ventricular failure is not a contraindication to IABP therapy, and IABP can be an effective means of controlling refractory ventricular arrhythmia 2