Transthoracic intraaortic balloon pump support: experience in 39 patients

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Medical Devices

Background:

• Intraaortic balloon pump (IABP) counterpulsation is a critical mechanical circulatory support.
• Percutaneous insertion is the preferred method for IABP placement.
• Transthoracic IABP insertion is reserved for cases where percutaneous approaches are not feasible or have failed.

Purpose of the Study:

• To evaluate the outcomes and complications associated with transthoracic intraaortic balloon pump (IABP) insertion.
• To determine the survival rates and feasibility of transthoracic IABP as a secondary support option.

Main Methods:

• Retrospective analysis of patients undergoing open-heart procedures between June 1982 and July 1985.
• Inclusion criteria: patients requiring IABP support where percutaneous attempts failed or were contraindicated.
• Data collection on patient demographics, complications, survival, and device removal procedures.

Main Results:

• 39 patients (1.5%) required transthoracic IABP insertion out of 2,570 open-heart procedures.
• The mean age was 64.9 years, with 62% males.
• Complications included mediastinal infection (2.5%), balloon rupture (5%), and cerebrovascular accidents (10%).
• Overall survival was 44%, with 81% survival in patients weaned from support.
• No deaths were directly attributed to the transthoracic IABP.

Conclusions:

• Transthoracic IABP is a feasible and reasonable second-line option for patients requiring intraaortic balloon counterpulsation when other methods are not possible.
• Device removal was successful without sternotomy in the majority of weaned patients (90%).
• Careful patient selection and management are crucial for optimizing outcomes with transthoracic IABP.