Transthoracic intra-aortic balloon pump in open heart operations: Techniques and outcome

Objective-During open heart surgery, direct transthoracic insertion of the intra-aortic balloon pump (IABP) is an alternative to the routine transfemo ral insertion especially in the presence of severe peripheral vascular dise ase. Methods-Over 19 years (1980-1998), 646 patients were treated with IABP, In 24 of them, the balloon was inserted transthoracic (TIABP) due to failure o f transfemoral insertion in 13 or extensive occlusive aorto-iliac disease i n 11 cases, Results-early mortality was 58.3% in patients having TIABP compared to 46.1 % in patients with transfemoral IABP insertion (p > 0,2), Of the 24 patient s receiving IABP transthoracic, none suffered vascular injury (i,e, perfora tion or dissection). Complications which could be related to TIABP occurred in 10 patients: 3 balloon ruptures, 1 mediastinal haemorrhage, 3 cerebrova scular accidents, 1 post-operative mediastinitis, and 2 late graft infectio ns. Conclusions-TIABP is a useful alternative when transfemoral insertion of IA BP is not feasible or hazardous because of occluded or severely diseased il io-femoral arteries. Being a second choice and a more invasive treatment, t ransthoracic IABP is associated with increased mortality.