Abstract 3275: Compromize of Visceral Arteries by Intraaortic Balloon Pump as a Consequence of Anatomical to Device Length Mismatch
Background: Intraaortic balloon pump (IABP) insertion is a widely and liberally used option in patients requiring cardiocirulatory support. However, acute renal failure and mesenteric ischemia are well known complications in these critical patients. Based on frequent computertomographic (CT) findings of balloon malposition in the abdominal aorta compromising coeliac trunk (TC), superior mesenteric artery (SMA) and renal arteries (RA) we made a systematic review of IABP patients receiving CT evaluation to reveal frequency of compromise, reasons and clinical relevance.
Methods: In 2008 a total of 378/3527 cardiac surgery pts ((10.7%) received perioperative IABP support. IABP balloon size was chosen according to patient’s height and manufacturer’s recommendations. In 48/378 pts. (12.7%) thoracic and abdominal CT was performed under IABP support because of clinically suspected mesenteric ischemia (balloon sized 40cc: n=36, 34cc: n=12, 30cc: n=2). Proximal and distal balloon position was verified regarding affection of all visceral arteries. Anatomical distance of left subclavian artery to coeliac trunk (SA-TC) was measured in all patients and related to recommended balloon length.
Results: Age was 67.9±11.9y, 27.1% were female, height was 170±8 cm. Proximal balloon positioning was 100% correct based on chest X-ray evaluation and appropriate in 46/48 based on CT. In 44/48 (91.7%) of all patients compromise of at least one visceral artery was found (91.7% TC, 72.9% SMA, 29.1% NA). SA-TC distance was 240±20mm leading to an anatomical to device length mismatch in 73.8% of all patients. Spinal deformations including sintering of vertebral bodies were found in 83.3%. Mesenteric ischemia was confirmed by CT in 10 pts. leading to laparotomy in 6 pts. Renal replacement therapy was required in 66.7%. Overall hospital mortality was 58.3%.
Conclusion: Despite meeting general recommendations and correct proximal balloon positioning a length mismatch is evident in most patients potentially leading to mesenteric and renal ischemia. Reasons might be spine malformations in an aging population. Smaller than recommended balloon sizes are necessary to reduce this significant problem.