Visceral arterial compromise during intra-aortic balloon counterpulsation therapy.
BACKGROUND
Intraaortic balloon pump (IABP) therapy is a widely used method of circulatory support. Based on frequent findings of balloon malposition with visceral arterial compromise on computerized tomographic (CT) imaging studies, we conducted a systematic review of cardiac surgical IABP patients with available CT scans to determine reasons, incidence, and clinical relevance of malposition.


RESULTS
From January 2007 to March 2009, a total of 621 of 7756 cardiac surgical patients (8.0%) received perioperative IABP support, of whom 63 (10.1%) received a thoracoabdominal CT scan during IABP support. Proximal and distal balloon positions were analyzed. The anatomic distance from the left subclavian artery to celiac trunk and aortic transverse diameter were measured in all patients and compared with implanted balloon dimensions. Mean age was 67.1±11.9 years; 33.3% were female, and height was 169±9 cm. Based on radiography, proximal balloon position was correct in 96.8% but only appropriate in 38.1% based on CT. In 61 of 63 patients, compromise of at least 1 visceral artery was found: celiac trunk, 96.8%; superior mesenteric artery, 87.3%; and renal arteries, 66.7%. Left subclavian artery to celiac trunk distance was 241±23 mm, and balloon length was 248±17 mm and corresponded to an anatomic to balloon length mismatch in 68.2%. Spinal deformations were found in 42.9%. Laparotomy for mesenteric ischemia was required in 23.8%. Hospital mortality rate was 60.3%.


CONCLUSIONS
IABP malposition was commonly identified by CT. Reasons included incorrect proximal balloon position as well as an anatomic-to-balloon length mismatch. Thus, shorter than recommended balloon sizes and better positioning strategies had to be considered.
Rastan
Ardawan Julian
AJ
University of Leipzig, Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany. rastan@rz.uni-leipzig.de
Tillmann
Eugen
E
Subramanian
Sreekumar
S
Lehmkuhl
Lukas
L
Funkat
Anne Kathrin
AK
Leontyev
Sergej
S
Doenst
Torsten
T
Walther
Thomas
T
Gutberlet
Matthias
M
Mohr
Friedrich Wilhelm
FW
D000368:Aged; D001011:Aorta / Q000473:pathology; D001027:Aortography; D002445:Celiac Artery / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects*; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging*; D008875:Middle Aged; D012077:Renal Artery / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*