Vascular complications of intraaortic balloon counterpulsation

Leigh I G Iverson, Gary Herfindahl, Roger R. Ecker, J Nilas Young, Coyness L. Ennix, John Lee, Cathy Dunning, Ann Whisenant, Ivan A. May

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Abstract

Between February 1973 and December 1986, 4,787 patients underwent open heart surgery at Samuel Merritt Hospital. Retrospective analysis revealed 395 (8 percent) consecutive patients who required hemodynamic support with the intraaortic balloon pump. Thirty percent of the patients had preoperative placement, 56 percent needed the balloon in order to wean from cardiopulmonary bypass, and 14 percent required placement in the postoperative period. The intraaortic balloon pump was instituted with multiple techniques and insertion sites. Three hundred eighty-three balloon catheters (96 percent) were inserted through the groin by surgical cutdown or a percutaneous approach. The remaining devices were inserted through the aortic arch. A 12 F. catheter was utilized in 239 patients (61 percent) and a smaller 10.5 F. catheter was placed in 156 patients (39 percent). The hospital mortality rate was 47 percent. Seventy-two of the 395 patients (24 percent) sustained vascular complications related to balloon use. Major complications occurred in 43 patients. Twenty-nine patients sustained minor complications that resolved spontaneously with balloon removal. Risk factors evaluated included patient gender, New York Heart Association class, catheter size, method of introduction, duration of counterpulsation, and presence of symptomatic peripheral vascular disease. Since percutaneous placement was associated with a significant decrease in complications, we concluded that use of the smaller 10.5 F. catheter placed percutaneously is the safest means of employing the intraaortic balloon pump. A monitoring line is placed percutaneously through the femoral artery in high-risk patients before operation. This allows easier access for intraaortic balloon pump placement in hypotensive patients. The presence of a clinical history of peripheral vascular disease was also a highly significant risk factor for vascular complications. Other risk factors increasing the likelihood of vascular compromise included catheter size and duration of counterpulsation.

Original languageEnglish (US)
Pages (from-to)62-66
Number of pages5
JournalThe American Journal of Surgery
Volume154
Issue number1
DOIs
StatePublished - 1987
Externally publishedYes

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ASJC Scopus subject areas

  • Surgery

Cite this

Iverson, L. I. G., Herfindahl, G., Ecker, R. R., Young, J. N., Ennix, C. L., Lee, J., Dunning, C., Whisenant, A., & May, I. A. (1987). Vascular complications of intraaortic balloon counterpulsation. The American Journal of Surgery, 154(1), 62-66. https://doi.org/10.1016/0002-9610(87)90297-2