Clinical experience with intra-aortic balloon counterpulsation in 112 consecutive patients

Intra-aortic balloon pumping (IABP) was attempted in 112 consecutive patients, resulting in successful placement in 49 of 50 (98%) patients when the percutaneous technique was used and in 60 of 62 (97.3%) patients when the surgical technique was used. Complications following acute myocardial infarction and perioperative problems were the two most frequent (47% and 52%, respectively) indications for IABP. A favorable survival was observed in patients with acute myocardial infarction with ventricular septal defect undergoing surgery after IABP (80%) and in patients in whom IABP was used in the perioperative setting (57.6%); survival remained poor in patients with postinfarction shock or severe heart failure (20% and 23%, respectively). Complications related to IABP occurred in 23 (20.5% patients but tended to occur more frequently in patients undergoing placement by the percutaneous route than by the surgical route (31% vs 9.6%; p less than 0.03) and in patients over age 70. Thus IABP can be successfully inserted in the majority of patients, but the high complication rate, especially with the percutaneous route, suggests caution in its indiscriminate use, particularly in patients whose mortality remains high despite its use.