Abstract
In the twenty-first century, there are several mechanical options for the support of a failing heart. One of the oldest methods is intra-aortic balloon pump (IABP), also known as “counterpulsation.” Despite the proliferation of other options, IABP remains the most common assist device for several reasons: it is minimally invasive, does not require extracorporeal handling of blood, causes minimal hemolysis, and can be inserted in multiple settings (catheterization lab, operating room, intensive care unit, etc.) by both surgeons and interventional cardiologists. This chapter will review the indications for IABP counterpulsation, describe the physiologic mechanisms supporting its use, describe the technique of insertion as well as potential complications, and finally describe the outcomes reported by clinical trials.