title: Transthoracic intra-aortic balloon pump in open heart operations: techniques and outcome.
abstract: OBJECTIVE
  During open heart surgery, direct transthoracic insertion of the intra-aortic balloon pump (IABP) is an alternative to the routine transfemoral insertion especially in the presence of severe peripheral vascular disease.
  
  
  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 of transfemoral insertion in 13 or extensive occlusive aorto-iliac disease in 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 patients receiving IABP transthoracic, none suffered vascular injury (i.e. perforation or dissection). Complications which could be related to TIABP occurred in 10 patients: 3 balloon ruptures, 1 mediastinal haemorrhage, 3 cerebrovascular accidents, 1 post-operative mediastinitis, and 2 late graft infections.
  
  
  CONCLUSIONS
  TIABP is a useful alternative when transfemoral insertion of IABP is not feasible or hazardous because of occluded or severely diseased ilio-femoral arteries. Being a second choice and a more invasive treatment, transthoracic IABP is associated with increased mortality.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Rikshospitalet, Oslo, Norway. osama.arafa@rikshospitalet.no
authors.forename: O E
authors.initials: OE
authors.lastname: Arafa
authors.forename: O R
authors.initials: OR
authors.lastname: Geiran
authors.forename: J L
authors.initials: JL
authors.lastname: Svennevig
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002303:Cardiac Output, Low / Q000401:mortality* / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D019616:Thoracic Surgical Procedures; D013997:Time Factors; D016896:Treatment Outcome