A method to ease removal of surgically-introduced intra-aortic balloon counterpulsation catheters

A surgical cut-down may be necessary when an emergency intra-aortic balloon counterpulsation catheter insertion has to be performed. Closure requires reopening the wound to extract the catheter and close the arteriotomy, or a graft has to be presutured to allow simple ligation. These methods are cumbersome. A method permitting rapid surgical access and easy removal in an intensive care unit is highly desirable. Such an insertion technique that, after insertion, includes placement of transcutaneous hemostatic purse-string sutures was evaluated.

All intra-aortic balloon catheter insertions done between August 1996 and March 2000, where all patients underwent an attempt at percutaneous intra-aortic balloon insertion, were evaluated. Failure to insert the balloon percutaneously was followed by direct surgical exposure and insertion with the placement of 2 transcutaneous purse-string sutures. The balloon pump catheter was removed when deemed appropriate and hemostasis was achieved by compression (percutaneous), or by tying of the preplaced sutures followed by compression. Patients were followed and both groups were compared with respect to mortality and vascular complications and any other complications were noted.

There were 157 intra-aortic balloon insertions. Surgical introduction was required in 9 (5.7%) cases. These represent 17.3% of all emergency introductions. There was no statistical difference in original diagnosis, mortality, or vascular complications. The survivors (8/9) have been followed up for a mean of 2.8 years with no late complications.

The removable transcutaneous suture method permits easy intra-aortic balloon catheter insertion and easy removal in an intensive care unit. This method has not been associated with complications in the follow-up period (mean 2.8 years).