Effectiveness of intraaortic balloon counterpulsation

The effectiveness of intraaortic balloon counterpulsation (IABP) in the elderly was evaluated in a group of 63 patients with acute myocardial infarction (AMI) complicated by refractory left ventricular failure (L VF, n = 16), cardiogenic shock (CS, n = 32) or acute ventricular septal defect (VSD, n = 15). The mean age was 61 years (range: 32-78 years); 35 patients were under and 28 over the age of 65. ^ Failures of insertion of the IABP catheter were significantly more frequent in the elderly (37-5 v. 11-4%, P<0-05). The rate of major complications, which was 12- 7 % in the whole series, did not significantly differ between the two age groups. Patients with medical indications for IABP (LVF, CS) had an overall in-hospital mortality of 68-8%:-no difference was observed between young (67-7%) and elderly (70-6%) patients. In elderly patients with VSD, IABP was ineffective even when reparative surgery could be performed. Haemodynamic effects of IABP were evaluated in 32 medical patients who survived the 4th hour of treatment. All haemodynamic parameters improved in the early phase of pumping (within 4 h) except cardiac index and total systemic resistance, which were significantly modified after 12 and 24 h of-treatment, respectively. An early improvement in stroke index proved to be predictive of survival. N