INTRAAORTIC BALLOON PUMP - INDICATIONS AND COMPLICATIONS

Results obtained with intra-aortic balloon pumps (IABPs) at Harbor-UCL A Medical Center from 1990 to 1995 were reviewed to analyze the indica tions for its use as well as the incidence and types of vascular compl ications that occurred. Of 86 patients (53 men and 33 women) in whom p umps were used, 66 underwent coronary bypass, 14 underwent valve repla cement, and 6 underwent both coronary bypass/valve replacement. Thirte en (15%) deaths occurred (8 coronary bypass patients, 4 valve replacem ent patients, and 1 coronary bypass/valve replacement patient). The in dications for IABP were broadly classified as prophylactic or inabilit y to wean. Prophylactic IABP placement preoperatively occurred in 35 ( 41%) patients for profound ventricular dysfunction (27 patients), comp elling coronary anatomy including critical left main disease (7 patien ts), and unstable angina (1 patient). inability to wean occurred in 51 (59%) patients. Three patients (3.5%) developed major vascular compli cations resulting in limb ischemia. All three underwent thrombectomies , fasciotomies, and above-knee amputations; two patients subsequently died. Vascular reconstruction was performed in two patients as a direc t result of their vascular process. All three vascular complications o ccurred in women. Besides gender, there was no difference between IABP patients with or without vascular complications in terms of age or pr esence of diabetes, hypertension, smoking history, obesity, or known p eripheral vascular disease. These results indicate that IABPs are effe ctive both prophylactically and intraoperatively in patients who would not otherwise survive cardiac surgery.