Abstract 18267: Percutaneous Ventricular Device versus Intra-aortic Balloon Pump

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Abstract

Despite poor quality evidence and questionable benefit, the intra-aortic balloon pump (IABP) is a device that is currently utilized as part of the treatment and/or prevention of cardiogenic shock. However, its utility is limited because of its low levels of additional cardiac support as compared with other percutaneous devices. In order to provide stronger hemodynamic support and expectedly improved outcomes, percutaneous ventricular assist devices (pVAD), for example the Impella (Abiomed; Danvers, MA) or TandemHeart (Cardiac Assist; Pittsburgh, PA) were developed with greater levels of augmented output. In this meta-analysis we aimed to compare the efficacy and safety of pVAD and IABP as a preventive method or to assist during cardiogenic shock in short-term and long-term (within 30 days and 6 to 12 months after intervention, respectively) patient-centered outcomes. We included 8 studies (6 RCT and 2 non-randomized studies) with a total of 788 patients. The pooled analysis of the 8 studies demonstrated no difference between pVAD and IABP in short-term (OR 1.16, 95% CI 0.78 to 1.74; I2 = 53%) and long-term (OR 0.79, 95% CI 0.32 to 1.96; I2 = 0%) all-cause mortality. However, the pVAD use was associated with more cumulative adverse events, including acute kidney injury, limb ischemia, infection, major bleeding and vascular injury, as compared with IABP (OR 1.91, 95% CI 1.21 to 3.01; I2 = 49%). We performed Trial Sequential Analysis (TSA) only for the RCTs to control risks of random errors due to sparse data and repetitive testing of the accumulating data. The TSA showed no difference between interventions with regard to short-term all-cause mortality (OR 1.17, 95% CI 0.71 to 1.93). However, there were more adverse events in the pVAD group compared with the IABP group (OR 1.63, 95% CI 1.02 to 2.60). In conclusion, there is no difference between pVAD and IABP in short-term and long-term risk of all-cause mortality but IABP showed superiority over pVAD in terms of safety outcomes. Based on TSA for both outcomes, there is a continued need for further studies to reach a more definitive conclusion on this topic.

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