Implications for the vascular surgeon with prolonged (3 to 89 days) intraaortic balloon pump counterpulsation.
OBJECTIVE
The intraaortic balloon pump (IABP) is useful in the treatment of failing hearts. Although most experience with IABPs has been with acute short-term use, the safe duration of therapy and possible complications of long-term IABP use are uncertain. We evaluated the feasibility, management, and complications associated with long-term IABP therapy.


METHODS
Fifty consecutive patients with 87 IABPs were evaluated retrospectively. All patients had IABP support for greater than 72 hours. Results and complications were evaluated.


RESULTS
The mean duration of IABP support was 23.2 days. There were 21 IABP-related complications in 16 patients: (16 ischemic, three infections, two hemorrhage). The rate of complications was 0.13 per patient-week of support. Significant predictors of complications were total days of IABP support (p < 0.0001), use of multiple IABPs (p < 0.0001), and attempted but unsuccessful percutaneous insertions (p < 0.001). Complications led to 14 vascular procedures (five patch angioplasties, four bypass procedures, two major amputations, one fasciotomy, one groin exploration for hemorrhage, and one removal of an infected Dacron patch). Percutaneous removals had a 14% complication rate compared with none after operative removal (p = 0.02). Thirty-two patients survived (64%). Of the survivors, 27 underwent transplant.


CONCLUSIONS
Prolonged IABP therapy is feasible and is associated with an acceptable rate of complications. Operative removal is superior to percutaneous removal. Percutaneous removal should be limited to short-term therapy. There is no need for mandatory removal or site rotation based solely on indwelling time.
Manord
J D
JD
Department of Surgery, Ochsner Clinic, New Orleans, LA, USA.
Garrard
C L
CL
Mehra
M R
MR
Sternbergh
W C
WC
Ballinger
B
B
Ventura
H O
HO
Stapleton
D D
DD
Smart
F W
FW
Bowen
J C
JC
Money
S R
SR
D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000628:therapy; D016027:Heart Transplantation; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000009:adverse effects / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data