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Eur J Cardiothorac Surg 2002;22:491-492
© 2002 Elsevier Science NL

Letter to the Editor

Reduced vascular complication after IABP insertion using smaller sized catheter and sheathless technique

Cardiac Surgery and Cardiology Department, Regional Cardiac Center, Morriston Hospital, SA6 6NL, Swansea, UK

Received 19 April 2002; accepted 27 May 2002.

* Corresponding author. Tel.: +44-77-89661000
e-mail: ptotaro{at}yahoo.com

We read with interest the paper from Meharwal and Trehan regarding vascular complication following intra-aortic balloon pump (IABP) insertion in patients undergoing myocardial revascularization [1]. We congratulate our colleagues from New Delhi for their extensive experience and for the brilliant results achieved in this respect. We would, nonetheless, briefly share our experience and add a few comments.

Better outcome demonstrated by prophylactic use of IABP in high risk patients before surgical and/or interventional treatment has contributed to considerable changes in IABP usage and management. The percentage of elective prophylactic IABP insertion has been, indeed, gradually increasing [2]. The extended use of preoperative IABP has been also followed by a significant evolution of the technique of insertion. The sheathless technique has become the technique of choice for percutaneous insertion and has been correlated with a significant reduction in post-IABP vascular complication [3].

Our experience reflects this general trend. In our center, over the last 4 years, the percentage of IABP inserted postoperatively (in operating theatre and/or postoperative intensive care unit) has decreased from 38 to 19% of the total IABP used. Since March 2000, moreover, we started to use a ‘Profile Co-lumen 8Fr Catheter’(Datascope Corp., Fairfield, NJ) and since April 2000 we have been prospectively collecting data in a specific IABP registry.

Out of 192 patients who had IABP inserted during the period April 2000 to March 2002, 182 (95%) received a Profile 8Fr. Percutaneous insertion was performed in 179 (98.4%) and, although Profile 8Fr has been designed for both sheathed and sheathless insertion, 176 (96.7%) had sheathless insertion. Easy insertion was achieved in 171 (97.2%) of these patients and the augmentation was adequate in all of them. Similar to the experience of Meharwal and Trehan a 40 cc balloon was used in the majority of the patients. The duration of IABP ranged from 3 h to 21 days (median 46 h). The anticoagulation protocol remained unchanged regardless of the size of the catheter and the type of insertion.

In our series, out of the 179 patients receiving a Profile 8Fr Catheter with sheathless insertion, none of the 35 deaths (19%) were related directly to the insertion and/or the presence of the IABP. Furthermore, among the 144 survivors only one (0.67%) experienced limb ischemia requiring embolectomy and three patients (2.1%) experienced limb ischaemia that resolved with balloon removal. Our results, therefore, concur with those reported from the Benchmark Registry [4] and compare favorably with the observation reported by our colleagues from New Delhi [1]. The reduced incidence noted in our experience could be related to the extensive use of the sheathless technique and the use of a smaller sized catheter.

In conclusion, we agree that the IABP percutaneous sheathless technique insertion reduces the incidence of vascular complication and should be, therefore, considered the technique of choice. According to our experience, moreover, the use of a smaller sized catheter seems to further reduce the incidence of vascular complications requiring treatment, therefore confirming the preliminary observations by Kuki et al. [5].

References

1. Meharwal Z.S., Trehan N. Vascular complications of intra-aortic balloon insertion in patients undergoing coronary revascularization: analysis of 911 cases. Eur J Cardiothorac Surg 2002;21(4):741-747.[Abstract/Free Full Text]
2. Christenson J.T., Schmuziger M., Simonet F. Effective surgical management of high-risk coronary patients using preoperative intra-aortic balloon counterpulsation therapy. Cardiovasc Surg 2001;9(4):383-390.[Medline]
3. Tatar H., Cicek S., Demirkilic U., Ozal E., Suer H., Aslan M., Ozturk O.Y. Vascular complications of intraaortic balloon pumping: unsheathed versus sheathed insertion. Ann Thorac Surg 1993;55(6):1518-1521.[Abstract]
4. Ferguson J.J., 3rd, Cohen M., Freedman R.J., Jr., Stone G.W., Miller M.F., Joseph D.L., Ohman E.M. The current practice of intra-aortic balloon counterpulsation: results from the Benchmark Registry. J Am Coll Cardiol 2001;38(5):1456-1462.[Abstract/Free Full Text]
5. Kuki S., Taniguchi K., Masai T., Yoshida K., Yamamoto K., Matsuda H. Usefulness of the low profile "True 8" intra-aortic balloon pumping catheter for preventing limb ischemia. ASAIO J 2001;47(6):611-614.[Medline]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Praveen Menon Pasquale Totaro Aprim Youhana Vincenzo Argano Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Menon, P. Articles by Argano, V. Search for Related Content PubMed PubMed Citation Articles by Menon, P. Articles by Argano, V. Related Collections Cardiac - other Mechanical Circulatory Assistance Peripheral vascular