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Archives of cardiovascular diseases
Volume 112, n° 12
pages 792-798 (décembre 2019)
Doi : 10.1016/j.acvd.2019.04.009
Received : 1 Mars 2019 ;  accepted : 23 April 2019
Reviews

Is there still a role for the intra-aortic balloon pump in the management of cardiogenic shock following acute coronary syndrome?
Le ballon de contre pulsion intra-aortique a-t-il encore un intérêt dans la prise en charge du choc cardiogénique ?
 

Guillaume Leurent a, , Vincent Auffret a, Camille Pichard a, Marc Laine b, Laurent Bonello b
a Université de Rennes 1, Department of Cardiology, CHU de Rennes, Inserm, UMR 1099 LTSI, 35000 Rennes, France 
b Aix-Marseille Université, AP–HM, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Centre for CardioVascular and Nutrition research (C2VN), Inserm 1263, INRA 1260, Cardiology Department, Hôpital Nord, 13000 Marseille, France 

Corresponding author. Service de Cardiologie, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex, France.Service de Cardiologie, CHU de Rennes2, rue Henri-Le-GuillouxRennes cedex35033France
Summary

The intra-aortic balloon pump has been widely used in the management of cardiogenic shock. Reducing cardiac afterload and myocardial oxygen consumption, and improving coronary blood flow, this safe and simple mechanical circulatory support has been considered the cornerstone of cardiogenic shock management for decades. However, because it failed to provide any clinical benefit in recent randomized trials, the latest guidelines discourage its routine use in this clinical setting. Moreover, new percutaneous circulatory supports providing greater haemodynamic improvement have recently been developed. Thus, intra-aortic balloon pump use has declined considerably in this clinical setting. However, the device does retain a minor role in cardiogenic shock management – mainly in the setting of mechanical complication of acute coronary syndrome, and for left ventricular unloading in patients treated with extracorporeal life support.

The full text of this article is available in PDF format.
Résumé

La contre pulsion par ballonnet intra-aortique (CPBIA) a été largement utilisée dans la prise en charge du choc cardiogénique (CC). Parce qu’elle réduit la post-charge, améliore le débit coronaire et diminue les besoins myocardiques en oxygène, cette assistance mécanique circulatoire simple d’utilisation et sûre a longtemps été considérée comme la pierre angulaire de la gestion du CC pendant des décennies. Cependant, face à l’absence de bénéfice clinique associé à son utilisation dans de récents essais randomisés, les dernières recommandations ne préconisent plus son utilisation systématique dans ce contexte. De plus, des supports circulatoires alternatifs plus élaborés se sont récemment développés. Pour ces raisons, les implantations de CPBIA ont fortement chuté dans cette indication. Cependant, elle garde un rôle modeste à jouer dans la gestion du CC, notamment en cas de complication mécanique du syndrome coronaire aigu, ou à visée de décharge du ventricule gauche des patients traités par circulation extracorporelle de type ECLS.

The full text of this article is available in PDF format.

Keywords : Intra-aortic balloon pump, Cardiogenic shock, Myocardial infarction, Left ventricular unloading, Coronary flow

Mots clés : Ballon de contre pulsion intra-aortique, Choc cardiogénique, Infarctus du myocarde, Décharge ventriculaire gauche, Flux coronaire

Abbreviations : CS, ECMO, IABP, LV, PCI, STEMI




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