COMPLICATIONS OF INTRAAORTIC BALLOON COUNTERPULSATION - THE ROLE OF CATHETER SIZE AND DURATION OF SUPPORT IN A MULTIVARIATE-ANALYSIS OF RISK

Aims The aim of this study was to assess the risk of intra-aortic ball oon counterpulsation and to identify clinical and procedural variables that would predict complications. Methods and Results We analysed 381 consecutive patients who were treated between 1977 and 1995 at our ca theterization laboratory and/or medical intensive care unit. The compl ications considered relevant were limb ischaemia requiring catheter re moval, vascular injury, bleeding requiring transfusion, embolic events , and infection. In eight patients the balloon could not be inserted. The rate of complications for the remaining 373 patients was 12.9%. Be tween 1977 and 1980, surgical insertion was performed using a 12 Frenc h catheter with a complication rate of 30.4% (seven of 23 patients). P ercutaneous implantation, performed after 1981, had an overall complic ation rate of 11.7% (41 of 350 patients). Using thinner catheters for percutaneous placement was associated with a reduction in the rate of complications, from 20.7% (17 of 82 patients) for 12 French catheters to 9.9% (10 of 101 patients) for 10.5 French catheters (P=0.04), and 8 .4% (14 of 167 patients) for 9.5 French catheters (P=0.006). Multivari ate logistic regression analysis identified duration of counterpulsati on >48 h (odds ratio 3.6), catheter size (odds ratio 3.4 for 12 French catheters), peripheral vascular disease (odds ratio 2.7), and shock ( odds ratio 2.0) as independent risk factors for counterpulsation-assoc iated complications. When considering 9.5 French catheters only (167 p atients, all after 1992), the sole remaining independent risk factor w as duration of counterpulsation >48 h (odds ratio 3.8). Those patients with 9.5 French catheters in whom counterpulsation did not exceed 48 h had a low complication rate of 3.9%. Conclusion The rate of percutan eous intra-aortic balloon counterpulsation complications was thus sign ificantly reduced by employing thinner catheters. It was at an accepta ble level for 9.5 French catheters, where a long duration of counterpu lsation emerged as the most significant factor associated with complic ations. Whether using even thinner catheters in combination with a she athless implantation technique further minimizes the risk of counterpu lsation remains to be seen.