Vascular complications of the intraaortic balloon pump in patients undergoing open heart operations: 15-year experience

Background. The beneficial effects of the intraaortic balloon pump (IABP) i n providing circulatory support must be weighed against its complications, particularly its vascular trauma. Methods. Five hundred nine patients who underwent open heart operations at our institution and who were treated with the IABP from January 1980 throug h December 1994 were studied retrospectively to assess IABP-related vascula r complications and their independent preoperative predictors and the impli cations of IABP-related vascular complications on the patients' mortality, morbidity (clinical sepsis and organ failure), and longterm survival. Results. Early vascular complications occurred in 56 patients (11%) and maj or complications occurred in 41 patients (8%). The latter consisted of aort ic perforation in 1 patient, aortoiliac dissection in 2 patients, and limb ischemia in 38 patients. Logistic regression analysis identified concomitan t peripheral vascular disease (p < 0.001), elevated preoperative end-diasto lic pressure, small body surface area, and large catheter size (p < 0.05) a s independent risk factors for IABP-related major vascular complications in patients who survived the day of operation. Late IABP-related sequelae occ urred in 10 patients, 9 of whom had had early vascular complications. The p resence of vascular complications per se was not a significant independent factor among other risk factors for mortality, morbidity, or long-term surv ival. Conclusions. Careful clinical assessment of the aortofemoral vascular tree is a cornerstone of early diagnosis and early intervention and usually prev ents limb loss. The significant decrease in major vascular complications th at has occurred over the last 5 years can be explained by the increased use of catheters with smaller diameters. The timing of IABP insertion in relat ion to operation and the duration of IABP use were the only device-related risk factors identified for morbidity and survival. (Ann Thorac Surg 1999;6 7:645-51) (C) 1999 by The Society of Thoracic Surgeons.