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Complications of intra-aortic balloon counterpulsation. The role of catheter size and duration of support in a multivariate analysis of risk.

Abstract：

AIMS:The aim of this study was to assess the risk of intra-aortic balloon counterpulsation and to identify clinical and procedural variables that would predict complications. METHODS AND RESULTS:We analysed 381 consecutive patients who were treated between 1977 and 1995 at our catheterization laboratory and/or medical intensive care unit. The complications considered relevant were limb ischaemia requiring catheter removal, vascular injury, bleeding requiring transfusion, embolic events, and infection. In eight patients the balloon could not be inserted. The rate of complications for the remaining 373 patients was 12.9%. Between 1977 and 1980, surgical insertion was performed using a 12 French catheter with a complication rate of 30.4% (seven of 23 patients). Percutaneous implantation, performed after 1981, had an overall complication rate of 11.7% (41 of 350 patients). Using thinner catheters for percutaneous placement was associated with a reduction in the rate of complications, from 20.7% (17 of 82 patients) for 12 French catheters to 9.9% (10 of 101 patients) for 10.5 French catheters (P = 0.04), and 8.4% (14 of 167 patients) for 9.5 French catheters (P = 0.006). Multivariate logistic regression analysis identified duration of counterpulsation > 48 h (odds ratio 3.6), catheter size (odds ratio 3.4 for 12 French catheters), peripheral vascular disease (odds ratio 2.7), and shock (odds ratio 2.0) as independent risk factors for counterpulsation-associated complications. When considering 9.5 French catheters only (167 patients, all after 1992), the sole remaining independent risk factor was duration of counterpulsation > 48 h (odds ratio 3.8). Those patients with 9.5 French catheters in whom counterpulsation did not exceed 48 h had a low complication rate of 3.9%. CONCLUSION:The rate of percutaneous intra-aortic balloon counterpulsation complications was thus significantly reduced by employing thinner catheters. It was at an acceptable level for 9.5 French catheters, where a long duration of counterpulsation emerged as the most significant factor associated with complications. Whether using even thinner catheters in combination with a sheathless implantation technique further minimizes the risk of counterpulsation remains to be seen.

journal_name

Eur Heart J

journal_title

European heart journal

authors

Scholz KH,Ragab S,von zur Mühlen F,Schröder T,Werner GS,Mindel L,Kreuzer H

doi

10.1053/euhj.1997.0802

subject

Has Abstract

pub_date

1998-03-01 00:00:00

pages

458-65

issue

eissn

0195-668X

issn

1522-9645

pii

S0195668X97908022

journal_volume

pub_type

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Complications of intra-aortic balloon counterpulsation. The role of catheter size and duration of support in a multivariate analysis of risk.