Cardiogenic shock is characterized by a myriad of clinical manifestations. Two leading causes of cardiogenic shock include acute myocardial infarction and acute on chronic heart failure. Acute decompensated heart failure with cardiogenic shock (ADHF-CS) is increasingly presenting a challenging scenario in terms of management and resources and there is limited information and guidelines on optimal treatment specifically for stage D Heart failure. While heart transplantation and left ventricular assist devices (LVADs) are available for the management of stage D ADHF, stabilizing patients during the transition and preserving end-organ function remain significant challenges. Temporary mechanical circulatory support (MCS) devices used for bridging include intra-aortic balloon pump (IABP), percutaneous ventricular assist devices such as Impella, venoarterial extracorporeal membrane oxygenation (VA-ECMO), each associated with its own device characteristics, indications and complications [
[1],
[2],
[3],
[4],
[5],
[6],
[7],
[8],
[9]].
IABP serves as a temporary mechanical circulatory support that can be used as a bridge to a durable LVAD (dLVAD) or heart transplant among patients with advanced heart failure, improving hemodynamics and cardiac output. IABP works by decreasing afterload and increasing diastolic aortic pressure, thereby augmenting coronary blood flow and peripheral perfusion. IABP utilization can lead to clinical stabilization in majority of patients preoperatively before advanced therapies can be implemented. Some studies show that preoperative IABP optimization may improve clinical outcomes among patients undergoing LVAD implantation. The use of IABP as a bridge to dLVAD among patients with non-acute coronary syndrome (ACS) related ADHF-CS is largely based on retrospective observational data [
[10],
[11],
[12],
[13]], and prospective high-quality evidence is lacking. The largest of these studies utilized data from the Interagency Registry for Mechanical Assisted Circulatory Support (INTERMACS). The patients who underwent LVAD implantation between 2006 and 2014 were examined. Among 2446 patients investigated, 433 (18 %) were supported with IABP preoperatively [
11]. Results showed that patients supported with IABP preoperatively had more advanced disease at baseline but no difference in the composite outcome of post-LVAD right heart failure, hepatic dysfunction, renal dysfunction, or death [
11]. Few other studies have explored the role of elective IABP implantation in cardiogenic shock patients prior to LVAD implantation and are summarized in
Table 1.
Table 1. Studies exploring role of IABP before LVAD implantation. Intra-aortic ballon pump (IABP), Left ventricular assistive device (LVAD), Pulmonary artery systolic pressure (PASP), Cardiac index (CI), Interagency Registry for Mechanical assistive Circulatory Support (INTERMACS), Pulmonary capillary wedge pressure (PCWP), Central venous pressure (CVP), Right Ventricular (RV), Left ventricular (LV), Heart rate (HR), Intensive care unit (ICU), Length of stay (LOS), Pulmonary artery pressure (PAP).