In-Hospital Complications of Percutaneous Intraaortic Balloon Counterpulsation

Abstract

Complications related to intraaortic balloon counterpulsation pumping (IABP) remain a problem despite the development of small caliber balloon catheter shafts and introducer sheaths. The authors report their experience in counterpulsation-related complications of 201 consecutive patients who underwent 212 percutaneous counterpulsation balloon insertions from June 1989 to June 1996 by use of balloons with 8-9.5 French shafts. Of these, 82% were men and 36 (18%) were women, with a mean age of 61 ±12 years. Indications for counterpulsation were acute myocardial infarction (AMI) (67%), severe left ventricular failure without AMI (20%), dilated cardiomyopathy (4%), unstable angina (3%), high-risk supported percutaneous coronary angioplasty (2%), and others (4%). IABP was instituted at the bedside in the intensive care unit in 82 patients (39%) and in the catheterization laboratory in 130 (61%). Median duration of counterpulsation was 48 hours (range 30 minutes to 25 days) with successful weaning from counterpulsation in 70% (148 of 212) of procedures. Overall in-hospital mortality rate was 45% (90 of 201). The overall complication rate was 22/212 (10.4%). Major complications were present in 10/212 procedures (4.7%): 6 patients with limb ischemia (1 death directly attributed to this complication, 1 with associated septicemia and limb amputation, 3 requiring surgical thromboembolectomy, and 1 with persistent limb ischemia treated medically until his death caused by intractable left ventricular failure), 2 with important bleeding (1 fatal despite vascular surgical repair and 1 requiring blood transfusion) and 2 with balloon rupture requiring vascular surgery. Minor complications were present in 12 procedures (5.7%), 6 with limb ischemia, 3 with local bleeding, and 3 with catheter dysfunction. All of these resolved after balloon removal and required no further intervention. When limb ischemia did develop it occurred after a median delay of 24 hours following balloon insertion (range 2 to 98 hours). The only predictor of limb ischemia among baseline clinical and procedure-related variables was an age greater than 60 years. Compared with previous recent studies, the rate of complications observed in this study performed with small balloon catheters was acceptably low. Limb ischemia was the most frequent complication, often occurred early, and required further inter vention in half the cases.

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References

Kantrowitz A. , Tjonneland S. , Freed PS, et al : Initial clinical experience with intra-aortic balloon pumping in cardiogenic shock. JAMA 203:135-140, 1968.

Mueller H. : Role of intra-aortic counterpulsation in cardiogenic shock and acute myocardial infarction. Cardiology 84:168-174, 1994.

Aguirre FV , Kern MJ , Bach R., et al: Intraaortic balloon pump support during high-risk coronary angioplasty . Cardiology 84:175-186, 1994.

Borowski A. , Ruhparwar A. , Korb H. : Mechanical circulatory support. 1. Intra-aortic balloon counterpulsation (IABP). Zentralbl Chir 120:159-165, 1995.

Bauriedel G. , Schwaiblmair M. , Kreuzer E., et al : Intraaortic balloon counterpulsation as a percutaneous therapy option in cardiogenic shock. Dtsch Med Wochenschr 123:834-838, 1995.

Subramanian VA , Goldstein JE , Sos TA, et al : Preliminary clinical experience with percutaneous intra-aortic balloon pumping. Circulation 62(suppl 1):1-123-I-129, 1980.

Patel JJ , Kopisyansky C. , Boston B., et al : Prospective evaluation of complications associated with percutaneous intraaortic balloon counterpulsation. Am J Cardiol 76:1205-1207, 1995.

Olsen PS , Arendrup H. , Thiis JJ, et al : Intraaortic balloon counterpulsation in Denmark 1988-1991. Eur J Cardiothorac Surg 7:634-636, 1993.

Makhoul RG , Cole CW , McCann RL : Vascular complications of the intra-aortic balloon pump: An analysis of 436 patients. Am Surg 59:564-568, 1993.

10.

Eltchaninoff H. , Whitlow PL : Complications immédiates et à distance du ballon de contrepulsion intraaortique percutané. Données récentes à propos d'une série de 200 patients consécutifs. Arch Mal Coeur Vaiss 86:1465-1470, 1993.

11.

Meharwal ZS , Trehan N. : Vascular complications of intra-aortic balloon insertion in patients undergoing coronary revascularization: Analysis of 911 cases. Eur J Cardiothorac Surg 21:741-747, 2002.

12.

Kumbasar SD , Semiz E. , Sancaktar O., et al : Mechanical complications of intra-aortic balloon counterpulsation. Int J Cardiol 70:69-73, 1999.

13.

Arafa OE , Pedersen TH , Svennevig JL, et al : Vascular complications of the intraaortic balloon pump in patients undergoing open heart operations: 15-year experience. Ann Thorac Surg 67:645-651, 1999.

14.

Bush T. , Sirbu H. , Zenker D., et al : Vascular complications related to intraaortic balloon counterpulsation: An analysis of ten years experience. Thorac Cardiovasc Surg 45:55-59, 1997.

15.

Cohen M. , Patel JJ , Dohad S., et al : Pilot prospective evaluation of counterpulsation with different intraaortic balloon volumes on cardiac performance in humans. Cathet Cardiovasc Diagn 36:82-87, 1995.

16.

Ohman EM , George BS , White CJ, et al : Use of aortic counterpulsation to improve sustained coronary artery patency during acute myocardial infarction. Results of a randomized trial . Circulation 90:792-799, 1994.

17.

Eltchaninoff H. , Dimas AP , Whitlow PL : Complications associated with percutaneous placement and use of intraaortic balloon counterpulsation . Am J Cardiol 71:328-332, 1993.

18.

Tatar H. , Çiçek S. , Demirkiliç U., et al : Vascular complications of intraaortic balloon pumping: Unsheathed versus sheathed insertion. Ann Thorac Surg 55:1518-1521, 1993.

19.

Lefemine AA , Kosowsky B. , Madoff I., et al: Results and complications of intra-aortic balloon pumping in surgical and medical patients . Am J Cardiol 40:416-420,1977.

20.

Harvey JC , Goldstein JE , McCabe JC, et al : Complications of percutaneous intra-aortic balloon pumping. Circulation 64(suppl II):II-114-II-117, 1981.

21.

Todd GJ , Bregman D. , Voorhes AB, et al : Vascular complications associated with percutaneous intraaortic balloon pumping . Arch Surg 118:963-964, 1983.

22.

Pelletier LC , Pomar JL , Galinanes M., et al : Complications of circulatory assistance with intra-aortic balloon pumping: A comparison of surgical and percutaneous technique. J Heart Transplant 5:138-142, 1986.

23.

Kantrowitz A. , Wasfie T. , Freed PS, et al : Intra-aortic balloon pumping from 1967 through 1982: Analysis of complications in 733 patients. Am J Cardiol 57: 976-983, 1986.

24.

Hedenmark J. , Ahn H. , Henze A., et al : Complications of intra-aortic balloon counterpulsation, with special reference to limb ischemia Scand J Thorac Cardiovasc Surg 22:123-125, 1988.