THE INTRAAORTIC BALLOON PUMP FOR POSTCARDIOTOMY HEART-FAILURE - EXPERIENCE WITH 169 INTRAAORTIC BALLOON PUMPS

The intraaortic balloon pump (IABP) is usually the first mechanical device inserted for perioperative heart failure. In the present study we have reviewed our experience with 169 IABP insertions with emphasis on IABP complications, route of insertion, and identification of predictors of mortality. Between January 1, 1984 and March 31, 1993 3 591 adult patients underwent cardiac surgical procedures, 169 of whom (4.7%) had an lABP inserted preoperatively (7 patients, 4.1%), intraoperatively (109 patients, 64.5%), or postoperatively (53 patients, 31.4%). There were 137 men (81.1%) and the mean age was 60.2 +/- 8.8 years (28-78 years). Operations included 149 coronary bypass grafting (CABG) (4.6%, 149/3 209), 6 valve replacements, single or double (2.4%, 6/255), and 14 valves combined with CABG (11.0%, 14/127). The IABP was used more frequently in reoperations (14.8%, 80/542), compared to primary operations (2.9%, 89/3049), p < 0.001. It was also more frequently used after emergency operations (50.7%, 39/77), than after elective operations (3.7%, 130/3514), p < 0.001. In 119 patients femoral insertion was performed (13 percutaneously and 106 surgically), while 50 patients had an intraaortic insertion. The mean duration of IABP support was 50 hours (0.5-576 hours). There were 8 (4.7%) complications related to the balloon pump, all after femoral insertion 13 after transcutaneous and 5 after surgical. insertions). Six of the complications occurred when the IABP was inserted intraoperatively and 2 postoperatively. The complications were 7 cases of leg ischemia (88%) and 1 groin wound infection. Surgical intervention was needed in 5 patients: thrombectomy + fasciotomy (2), femoro-femoro cross-over bypass (2), and wound debridement (1). The perioperative mortality was 47.9%. Riskfactors for perioperative mortality were found to be: preoperative myocardial ischemia and combined cardiac surgical procedures. Sex, age, classical preoperative riskfactors, route of insertion, and number of distal anastomoses in CABG did not influence the perioperative mortality. Balloon-related complications were not predictive of death.