Document Detail

Visceral arterial compromise during intra-aortic balloon counterpulsation therapy.
MedLine Citation:
PMID:  20837932     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Intraaortic balloon pump (IABP) therapy is a widely used method of circulatory support. Based on frequent findings of balloon malposition with visceral arterial compromise on computerized tomographic (CT) imaging studies, we conducted a systematic review of cardiac surgical IABP patients with available CT scans to determine reasons, incidence, and clinical relevance of malposition.
METHODS AND RESULTS: From January 2007 to March 2009, a total of 621 of 7756 cardiac surgical patients (8.0%) received perioperative IABP support, of whom 63 (10.1%) received a thoracoabdominal CT scan during IABP support. Proximal and distal balloon positions were analyzed. The anatomic distance from the left subclavian artery to celiac trunk and aortic transverse diameter were measured in all patients and compared with implanted balloon dimensions. Mean age was 67.1±11.9 years; 33.3% were female, and height was 169±9 cm. Based on radiography, proximal balloon position was correct in 96.8% but only appropriate in 38.1% based on CT. In 61 of 63 patients, compromise of at least 1 visceral artery was found: celiac trunk, 96.8%; superior mesenteric artery, 87.3%; and renal arteries, 66.7%. Left subclavian artery to celiac trunk distance was 241±23 mm, and balloon length was 248±17 mm and corresponded to an anatomic to balloon length mismatch in 68.2%. Spinal deformations were found in 42.9%. Laparotomy for mesenteric ischemia was required in 23.8%. Hospital mortality rate was 60.3%.
CONCLUSIONS: IABP malposition was commonly identified by CT. Reasons included incorrect proximal balloon position as well as an anatomic-to-balloon length mismatch. Thus, shorter than recommended balloon sizes and better positioning strategies had to be considered.
Ardawan Julian Rastan; Eugen Tillmann; Sreekumar Subramanian; Lukas Lehmkuhl; Anne Kathrin Funkat; Sergej Leontyev; Torsten Doenst; Thomas Walther; Matthias Gutberlet; Friedrich Wilhelm Mohr
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  122     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-14     Completed Date:  2010-10-01     Revised Date:  2011-06-27    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S92-9     Citation Subset:  AIM; IM    
University of Leipzig, Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
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MeSH Terms
Aorta / pathology
Celiac Artery / radiography*
Intra-Aortic Balloon Pumping / adverse effects*
Mesenteric Artery, Superior / radiography*
Middle Aged
Renal Artery / radiography*
Retrospective Studies
Subclavian Artery / radiography*
Tomography, X-Ray Computed / methods*
Comment In:
Circulation. 2011 May 10;123(18):e588; author reply e589   [PMID:  21555721 ]

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