Thoracic Intra-aortic Balloon Pumping (IABP) is a feasible alternative to routine transfemoral insertion

Introduction: The number of elderly patients with severe peripheral vascular disease in heart surgery is increasing, failure rate for insertion of transfemoral IABP is up to 21% (Santini). Thoracic IABP (TIABP) offers an alternative route to treatment.

Methods: In a retrospective analysis we reviewed our last 260 consecutive patients (pts.) who were treated with IABP. In 77 of them, the balloon was inserted into the ascending aorta during open heart surgery and explanted in survivors by transcutan procedure on ICU.

Results: Baseline characteristics as age, ejection fraction, NYHA status (mostly III and IV) emergency status and type of surgery did not differ significantly between both groups. 30-day mortality in this high-risk group of patients was 26% (20 pts.) having TIABP compared to 21, 9% (40 pts.) with transfemoral IABP insertion. Complications related to TIABP occurred in 2 patients: One died by mediastinitis, the second one by vascular injury. No cerebral or limb ischemia was observed. In the group with transfemoral IABP 3,3% (6 pts.) suffered from stroke and 10% (18 pts.) from compartment syndrome (p<0,05). Intestinal ischemia was observed in both groups but was not statistically significant. By logistic multivariate analysis age >70 years, peripheral vascular disease, high doses of noradrenaline and diabetes mellitus were parameter for an increased complication rate (p<0,05).

Conclusion: Transthoracic IABP is a second choice and a more invasive treatment, but offers an alternative if transfemoral route in a haemodynamically unstable patient is not possible.