Original Studies A Single Center Tertiary Care Experience Utilizing the Large Volume Mega 50cc Intra-Aortic Balloon Counterpulsation in Contemporary Clinical Practice Gautam K. Visveswaran, 1 * MD, Marc Cohen, 1 MD, FSCAI, Ahmed Seliem, 1 MD, Michael DiVita, 1 MD, Jonathan K. R. McNamara, 2 MD, Amar Dave, 2 MD, Najam Wasty, 1 MD, FSCAI, and David A. Baran, 1 MD Objective: Clinical outcomes and adverse events utilizing the large volume 50cc intra- aortic balloon (IAB) in contemporary clinical practice. Background: The newer large volume 50cc IAB, recently introduced into clinical practice offers improved diastolic augmentation and better left ventricular (LV) unloading compared to the older 40cc IAB. Methods: In 150 consecutive patients who received intra-aortic balloon counter- pulsation (IABC) with a 50cc balloon from 2011 to 2015, we retrospectively analyzed demographic, clinical, laboratory, and hemodynamic variables, adverse events and sur- vival to discharge from index hospitalization. Results: Median LVEF was 20%. The most common indication was cardiogenic shock (CS) in 100 patients. Median duration of IABC was 92.5 hr. 95% of patients were free of any IAB device related complica- tions. Five patients received a transfusion for bleeding causally related to IABC. 70 of the 150 patients who received MCS with IABC with no escalation of therapy, recovered and were discharged alive. Fifteen patients were stabilized on IABC and bridged to orthotopic heart transplant. All 15 were discharged alive. Thirty-four patients were initi- ated on IABC and escalated to VAD and/or Impella/Tandem Heart, with 24 patients sur- viving to hospital discharge. Overall survival to hospital discharge for the 150 patients was 72.7%. Conclusion: IABC using a larger volume 50cc balloon appears effective as a first line percutaneous MCS strategy in a large fraction of critically ill cardiac patients 1 Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey 2 Division of Internal Medicine, Newark Beth Israel Medical Center, Newark, New Jersey Disclosure: Gautam K. Visveswaran has received reimbursement for travel expenses and research honorarium from Maquet. Marc Cohen has received reimbursement for travel expenses and consulting fees from Maquet. David A. Baran has received reimbursement for travel expenses and speakers fees from Maquet. The other authors have no conflict of interest to declare. Funding: Maquet Cardiovascular LLC provided research funding for the study. *Correspondence to: G. K. Visveswaran, MD, Division of Cardiolo- gy, Newark Beth Israel Medical Center, Newark, NJ 07112. E-mail: gaukart@gmail.com AbbreviationsAMI, acute myocardial infarction; BARC, bleeding academic research consortium; CABG, coronary artery bypass grafting; CAD, coronary artery disease; CICU, cardiac intensive care unit; CHF, congestive heart failure; CO/CI, cardiac output/ cardiac index; DBP, diastolic blood pressure; IAB, intra-aortic balloon; IABC, intra-aortic balloon counterpulsation; LVEF, left ventricular ejection fraction; LVEDP, left ventricular end diastolic pressure; MI, myocardial infarction; PADP, pulmonary artery dia- stolic pressure; PASP, pulmonary artery systolic pressure; PCWP, pulmonary capillary wedge pressure; pRBC, packed red blood cells; RA, right atrial pressure; RVEDP, right ventricular end diastolic pressure; SBP, systolic blood pressure. Received 31 May 2016; Revision accepted 11 December 2016 DOI: 10.1002/ccd.26908 Published online 00 Month 2017 in Wiley Online Library (wileyonlinelibrary.com) V C 2017 Wiley Periodicals, Inc. Catheterization and Cardiovascular Interventions 00:00–00 (2017)