Intra-aortic balloon counterpulsation therapy

Percutaneous coronary intervention in the presence of impaired left ventricular function is associated with significant mortality and morbidity. Intra-aortic balloon counterpulsation simultaneously increases coronary blood flow, by augmenting the diastolic aortocoronary pressure gradient, and decreases myocardial oxygen demand, by reducing the end-diastolic pressure, and therefore the afterload. This makes it an attractive means of ameliorating ischaemia and consequently enhancing cardiac output. Although contemporary randomized control trials have demonstrated that routine placement of an intra-aortic balloon pump (IABP) is not mandatory, a standby approach is recommended, as an important minority of patients require bail-out IABP insertion in the event of haemodynamic compromise. IABP therapy remains the safest and most readily available mechanical assist device to deploy in the catheter laboratory setting, with deployment guided by salient haemodynamics and the individual clinical scenario.