Intra-aortic balloon pump associated vascular complications in cardiac surgical patients: the past and the future

Despite low profile and percutaneous insertion intra-aortic balloon pumps (IABP) are prone to local vascular complications with important impact on outcome in cardiac surgery patients. The aim of this study was to evaluate number and sort of vascular complications related to IABP insertion within a 12-year period. IABP was used in 485 patients from 01/1996 to 12/2008. Due to the device used, we divided our cohort into two groups: group I (225 patients; 01/1996 to 12/2002) and group II (260 patients; 01/2003 to 12/2008). Hospital mortality, overall combined rate of stroke and myocardial infarction, reoperation as well as specific vascular complications (groin hematoma, limb ischemia, compartment syndrome, wound infection, arterial trauma, and limb amputation) were assessed. Implantation-related factors, such as open or percutaneous technique, sheath usage and size, and balloon size were recorded. Mean duration of IABP use was 2.1 ± 1.8 days in group I and 2.6 ± 3.1 days in group II, (p = 0.56). Hospital mortality (group I: 46% vs group II: 43%, p = 1.00) as well as overall complications such as early cardiothoracic reoperation, stroke, myocardial infarction, and death (group I: 36% vs group II: 33%, p = 1.00) were comparable. Vascular complications were more frequent in group I (17.4% vs 9.7%, p = 0.01) with a higher rate of groin hematoma (6.8 vs 1.4%, p = 0.003) and limb ischemia (11.1 vs 6.5%, p = 0.005). Wound infection (1.37 vs 0.38%, p = 0.33) and amputation rates (three patients required below-knee amputation; 0.9 vs 0.38%, p = 0.5) were similar in both groups. We observed significant differences in IABP-related vascular complications between the two 6-year periods, with a lower rate of complications during the past 6 years. The ongoing improvement of invasive techniques and evolving balloon technologies allow the safe use of IABP to benefit high-risk patients undergoing cardiac surgery.