The Use of Intraaortic Balloon Counterpulsation in Cardiac Surgery in Germany

Background: While the use of intraaortic balloon pump (IABP) in the context of patients undergoing interventional coronary revascularization has regressed, the role of IABP for different indications in patients undergoing cardiac surgery remains less clear. Prior to updating the S3-guideline for IABP use in patients undergoing cardiac surgery, we aimed at elucidating the current practice of IABP in German cardiac surgery centers.

Method: An online survey consisting of 18 items was designed. The heads of all 78 German cardiac surgery departments were invited to participate by the guideline working group at the German Society for Thoracic and Cardiovascular Surgery.

Results: Fifty-three (68%) departments took part in the survey. For 2020, a total of 845 IABP runs, thereof 35% preoperatively, 53% intraoperatively, and 24% postoperatively, respectively, were reported. 61% of centers reported that there is no local standard operating procedure for IABP use. The most commonly accepted criteria for IABP use were: severely impaired left-ventricular function (51%), cardiogenic shock (47%), mechanical complications of acute myocardial infarction (41%), and prophylactic use in stable patients with acute myocardial infarction (25%). An IABP use for a maximum of 5 days was considered appropriate by 43% of centers, 22% do not see time limits for IABP use. During IABP use, 69% of centers use heparin for anticoagulation while 18% do not anticoagulate. The majority of centers (65%) use frequency reduction for IABP weaning. 89% reported that the use of IABP regressed in favor of other mechanical assist systems between 2015 and 2020. The favored alternatives were as follows: extracorporeal life support (76%), Impella 5.0/5.5 (51%), Impella CP (39%), and Impella 2.5 (41%). In particular, the Impella pumps were considered to provide more effective circulatory support (77%), but also to cause higher complication rates compared with IABP (68%). The centers reported that IABP was generally not accepted (20%) or was considered useless (53%) by the cardiologists in the heart team. Concerning the current S3-guideline, 37% reported that the guideline had changed their IABP practice, while 61% were not influenced by the guideline and 2% were not aware of the guideline.

Conclusion: IABP is a frequently used option for mechanical circulatory support in patients undergoing cardiac surgery. However, its use is increasingly replaced by other more invasive support devices. The current update of the S3 guideline needs to address the differential indication for IABP versus other mechanical circulatory support options.

Publication History

Article published online:
03 February 2022