Complications of circulatory assistance with intra-aortic balloon pumping: a comparison of surgical and percutaneous techniques.

One hundred and two consecutive patients who underwent circulatory support with intra-aortic balloon pumping were reviewed. All patients underwent surgery for coronary bypass, resection of ventricular aneurysm, or valve replacement. Circulatory assistance was initiated preoperatively in 21 patients and postoperatively in 81 patients. Insertion of the balloon catheter was attempted randomly by the surgical technique or by the percutaneous method in 47 patients each. The surgical insertion failed in five patients (10.6%), and the percutaneous method was a failure in four patients (8.5%). All failures with both techniques occurred when catheter insertion was attempted postoperatively. Among 85 patients studied for complications, there were 17 vascular and 3 wound complications (23.5%). The complication rate with the surgical technique was 11.4% and that of the percutaneous insertion 30.6%, a difference that is significant. The mean duration of circulatory support was significantly longer in patients who developed vascular complications (123 hours vs 78 hours). Vascular complications resulted in the loss of limb in two patients, one in each group. There were two deaths directly related to the use of circulatory assistance, one from perforation of the iliac artery and one from acute renal failure following revascularization of a severely ischemic limb, both in the percutaneous group. Thus, percutaneous balloon insertion has a failure rate similar to surgical insertion but a higher rate of complications, partly caused by percutaneous removal of the catheter. Practical recommendations are made in regard to the use and management of the technique.