IMPLICATIONS FOR THE VASCULAR SURGEON WITH PROLONGED (3 TO 89 DAYS) INTRAAORTIC BALLOON PUMP COUNTERPULSATION

Purpose: The intraaortic balloon pump (IABP) is useful in the treatmen t of failing hearts. Although most experience with IABPs has been with acute short-term use, the safe duration of therapy and possible compl ications of long-term IABP use are uncertain. We evaluated the feasibi lity, management, and complications associated with long-term IABP the rapy. Methods: Fifty consecutive patients with 87 IABPs were evaluated retrospectively. All patients had IABP support for greater than 72 ho urs. Results and complications were evaluated. Results: The mean durat ion of IABP support was 23.2 days. There were 21 IABP-related complica tions in 16 patients: (16 ischemic, three infections, two hemorrhage). The rate of complications was 0.13 per patient-week of support. Signi ficant predictors of complications were total days of IABP support (p < 0.0001), use of multiple IABPs (P < 0.0001), and attempted but unsuc cessful percutaneous insertions (p < 0.001). Complications led to 14 v ascular procedures (five patch angioplasties, four bypass procedures, two major amputations, one fasciotomy, one groin exploration for hemor rhage, and one removal of an infected Dacron patch). Percutaneous remo vals had a 14% complication rate compared with none after operative re moval (p = 0.02). Thirty-two patients survived (64%). Of the survivors , 27 underwent transplant. Conclusions: Prolonged IABP therapy is feas ible and is associated with an acceptable rate of complications. Opera tive removal is superior to percutaneous removal. Percutaneous removal should be limited to short-term therapy. There is no need for mandato ry removal or site rotation based solely on indwelling time.