Mechanical circulatory assistance in the management of patients in coronary care unit.

Mechanical circulatory assistance was attempted in 73 patients at our coronary care unit from January 1, 1983, to January 1, 1987. Of these, 62 were men and 11 were women. The intra-aortic balloon pump (IABP) was successfully inserted by percutaneous femoral puncture in all cases. Indications for an IABP included: acute infarction and haemodynamic deterioration (23 cases), refractory congestive heart failure (2 cases), hypotension, ST-T changes and chest pain complicating coronarography or coronary angioplasty procedures (16 cases), unstable angina pectoris resistent to medical therapy, treated by coronary angioplasty (16 cases) and preoperative haemodynamic coverage (16 cases). The overall major complication rate of IABP was 1.5%. Our experience supports aggressive management of cardiogenic shock, i.e. early angioplasty or cardiac surgery, which considerably influences the functional status and the long-term survival rate (7/9 cases) over medical therapy combined with IABP (2 of the 14 patients are alive). The IABP was also effective in managing other high-risk patients when it was combined with some form of definitive cardioprotective mechanical correction, i.e. aneurysmectomy, valve replacement, coronary recanalization procedure. When the counterpulsation was used prophylactically, no interventional myocardial infarctions or deaths occurred; the survival rate was 27/32 patients for a 22 month average follow-up. It is suggested that the clinical results and late survival were improved by use of IABP in selected patients undergoing coronary angioplasty or open-heart surgery.