Mechanical complications of intra-aortic balloon counterpulsation

Intra-aortic balloon counterpulsation (IABP) related complications in a het erogeneous group of patients who received an IABP before or after thromboly tic therapy and mechanical revascularization or in the management of refrac tory unstable angina and myocardial infarction related mechanical complicat ions were evaluated prospectively. Ninety-one patients were enrolled to the study. Mean IABP duration was 4.3+/-2.4 days. While the IABP was in place, three patients (3.3%) had femoral artery emboli, four patients (4.4%) had lower extremity ischemia that resolved after the removal of the balloon, ei ght patients (8.8%) had groin hematoma requiring blood transfusion (less th an or equal to 2 units), and four patients (4.4%) had intra-aortic balloon rupture. The relation of several risk factors to groin hematoma requiring l ess than or equal to 2 units blood transfusion, emboli, lower extremity isc hemia and to total complications was evaluated. A chi-squared analysis show ed that nadroparine use was more often complicated with emboli (P=0.00005) and ischemic events (emboli and/or lower extremity ischemia) (three patient s; 30% of nadroparine group vs, four patients; 4.9% of heparin group, P=0.0 05) and hypercholesterolemia (>200 mg/dl) was more often complicated with l ower extremity ischemia (P=0.017). Forward conditional logistic regression analysis did not show any relation between the risk factors identified and emboli, lower extremity ischemia, ischemic events and groin hematoma (P>0.0 5), but an inverse relation was found between IABP duration and total compl ications (P=0.0198). In conclusion, IABP related complications were found t o remain unchanged but were not life-threatening and were inversely related to IABP duration and this suggests shorter periods of IABP use whenever po ssible and one must be cautious to use low molecular weight heparin in pati ents with an IABP in place. (C) 1999 Elsevier Science Ireland Ltd. All righ ts reserved.