Usefulness of the low profile "True 8" intra-aortic balloon pumping catheter for preventing limb lschemia.

The most important limitation in the use of an intra-aortic balloon pumping (IABP) is the risk of vascular complications. Recently, an IABP catheter with an 8.0 French shaft and low profile that may decrease the risk of vascular morbidity has been developed. We evaluated the in vitro balloon performance and the prevention of limb ischemia in clinical use. An 8.0 French IABP catheter was compared with a standard 9.5 French catheter. Inflation time (IT), deflation time (DT), and changes in volume (V) generated by the balloon were measured during the pumping cycle in an experimental model. The inflation velocity (V/IT) and deflation velocity (V/DT) were calculated as parameters of balloon performance. At 120 bpm the V/IT and V/DT were 0.34 ml/msec and 0.28 ml/msec with the 8.0 French, and 0.33 ml/msec and 0.24 ml/msec with the 9.5 French catheter. Twelve patients with coronary artery disease, ranging in age from 41 to 87 years (mean, 66 years), who underwent IABP support, were divided into group 1 (8.0 French, n = 4) and group 2 (9.5 French, n = 8). Ankle-arm pressure index (API), lactate extraction ratio (LER) in the limb with IABP insertion, and cardiac index (CI) were measured at 1, 12, and 24 hours postoperatively. There were no major vascular complications and no counterpulsation related morbidity. There was no significant difference between the two groups with regard to age, duration of IABP support, and incidence of peripheral vascular disease and diabetes. The percentage of women patients was significantly higher in group 1 (100% vs. 25%), whereas body surface area was significantly smaller (1.45 +/- 0.14 vs. 1.68 +/- 0.12 m2). The API in group 1 were slightly higher than those in group 2 throughout the observed period (not significant). The LER and Cl showed no significant differences between the two groups. These results suggest that the 8.0 French IABP catheter with a low profile has an acceptable in vitro performance, and its clinical application may be effective in preventing limb ischemia in a high-risk subset of patients such as women and smaller patients.