A56-21 Comparative Outcomes of Lvad Versus Intra-aortic Balloon Pump (iabp) in Septic Cardiomyopathy With Mixed Shock Physiology: A Systematic Review and Meta-analysis

Rationale Septic cardiomyopathy, characterized by reversible left ventricular dysfunction in the setting of sepsis, presents a major therapeutic challenge when accompanied by mixed distributive and cardiogenic shock. Mechanical circulatory support has emerged as a bridge to recovery in these critically ill patients. The intra-aortic balloon pump (IABP) is traditionally used to augment coronary perfusion and reduce afterload, whereas the left ventricular assist device (LVAD) provides direct ventricular unloading and forward flow. This meta-analysis compared survival, lactate clearance, and right ventricular recovery between patients with septic shock-related cardiomyopathy supported with LVAD or IABP. Methods PubMed, Embase, and Scopus were systematically searched through October 2025 for observational and registry-based studies involving adult patients with septic cardiomyopathy receiving either IABP or LVAD. The main outcome was in-hospital mortality. Secondary outcomes included 48-hour lactate clearance, right ventricular recovery, and 30-day survival. A random-effects model was used to pool results, and consistency across studies was verified by sensitivity analysis. Results Nine studies including 1,742 patients (LVAD 612, IABP 1,130) met inclusion criteria. Overall in-hospital mortality was 42 percent in the LVAD group versus 59 percent with IABP (pooled odds ratio 0.61, 95 percent confidence interval 0.46-0.82, p = 0.001). Lactate clearance at 48 hours was significantly better with LVAD support (mean difference -1.8 mmol/L, 95 percent CI -2.9 to -0.7, p = 0.002). Right ventricular recovery occurred in 54 percent of LVAD patients compared with 37 percent of those supported by IABP (odds ratio 1.9, 95 percent CI 1.2-3.1, p = 0.005). Patients with combined distributive and cardiogenic physiology derived the most benefit from LVAD use, while those with isolated LV dysfunction and adequate vascular tone showed no clear mortality difference. IABP appeared most appropriate in transient or milder forms of septic cardiomyopathy where coronary perfusion support and afterload reduction were the main goals of therapy. Conclusions In septic cardiomyopathy with mixed shock physiology, LVAD support was associated with higher survival, faster lactate clearance, and greater right ventricular recovery compared with IABP. Early LVAD deployment may offer hemodynamic and metabolic advantages in severe cases, while IABP remains a useful option for short-term stabilization in less profound LV dysfunction. Further prospective studies are warranted to define optimal mechanical support strategies in sepsis-related cardiac failure.