PROSPECTIVE EVALUATION OF FACTORS ASSOCIATED WITH INTRAAORTIC BALLOONRUPTURE

The authors undertook a prospective analysis of all intraaortic balloo n catheter (IAB) insertions at Hahnemann University Hospital during an 18 month period. Attention was directed to balloon rupture and factor s associated with this complication. A total of 384 insertions were at tempted in 363 patients: 19 patients (5.2%) experienced balloon ruptur e. The mean time to rupture was 2.1 +/- 3.3 days (range 0-15 days). Al l ruptured IAB catheters were removed percutaneously without subsequen t complications. Ten balloons were subjected to leak testing and scann ing electron microscopy. All but one rupture appeared to be the result of balloon abrasion against atherosclerotic plaque. The puncture site occurred at variable distances from the proximal end of the balloon a t 9.4 +/- 8.3 cm. Comparison of patients with and without balloon rupt ure revealed several significant (p < 0.04) differences by univariate analysis (Table 1). No procedure related variables (IAB catheter size 9 versus 11 Fr, sheathless insertion, duration of counterpulsation) we re associated with rupture. Stepwise logistic regression analysis reve aled body surface area as the only independent predictor of balloon ru pture (p = 0.007). Intraaortic balloon rupture with 40 cc balloons, is directly related to the size of the patient. Evaluation of smaller ba lloons in patients with body surface area less than or equal to 1.8 m( 2) appears warranted to minimize IAB rupture.