Intraaortic Balloon Pumping in Cardiac Surgical Patients: A Nine-Year Experience

• Published in: The Annals of thoracic surgery Vol. 36; no. 2; pp. 125 - 131
• Main Authors: Pennington, D. Glenn, Swartz, Marc, Codd, John E., Merjavy, John P., Kaiser, George C.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.08.1983
• Subjects: Adult; Aged; Angina Pectoris - therapy; Assisted Circulation; Cardiac Surgical Procedures - mortality; Humans; Intra-Aortic Balloon Pumping - adverse effects; Intra-Aortic Balloon Pumping - methods; Intraoperative Care; Middle Aged; Postoperative Care; Postoperative Complications - therapy; Preoperative Care; Shock, Cardiogenic - therapy
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(10)60445-6

From March, 1973, to April, 1982, 378 of 5,546 patients (6.8%) undergoing cardiac operations had insertion of an intraaortic balloon pump (IABP). The 378 patients ranged in age from 19 to 84 years (mean, 58.2 years) and included 4.7% of patients undergoing coronary bypass grafting and 10.6% of patients undergoing valve replacement. An IABP was inserted preoperatively in 22 patients with unstable angina pectoris and in 33 patients with cardiogenic shock; intraoperatively in 252 patients who could not be weaned from cardiopulmonary bypass; and postoperatively in 71 patients who had hemodynamic deterioration. The IABP was inserted by femoral arteriotomy in 201 patients, by percutaneous femoral puncture in 161 patients, and by transthoracic aortotomy in 16 patients. All patients received daily infusions of low molecular weight dextran without heparin during the IABP period. Duration of IABP support ranged from 1 to 384 hours (mean, 37.3 hours). Out of 230 patients weaned from the IABP, 202 patients were discharged from the hospital for an overall survival rate of 53.4%. The overall incidence of complications was 11.6%. There were 8 IABP-related deaths (2.1%), which were due to ruptured aorta in 6 patients, aortic dissection in 1 patient, and helium embolus in 1. Survival was higher in patients with insertion by percutaneous femoral puncture (99/161; 61.5%) than in patients with insertion by femoral arteriotomy (99/201; 49.3%) ( p < 0.025), and lowest in patients with insertion by transthoracic aortotomy (4/16; 25%) ( p < 0.001). However, the incidence of major IABP-related complications was higher in patients with percutaneous insertion (9.9%) than in those with femoral arteriotomy insertion (3.5%) ( p < 0.005) due to the higher incidence of aortic rupture and ischemia of the leg. It is likely that differences in survival were related to the severity of ventricular failure rather than to the mode of IABP insertion.