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Eur J Cardiothorac Surg 2002;22:492-493
© 2002 Elsevier Science NL

Letter to the Editor

Reply to Totaro et al.

Z.S. Meharwal*, N. Trehan

Escorts Heart Institute And Research Centre, Okhla Road, New Delhi, India

Received 24 May 2002; accepted 27 May 2002.

* Corresponding author. Tel.: +91-11-6825000; fax: +91-11-6825013
e-mail: meharwal{at}hotmail.com

We thank Totaro et al. for their comments on our recent article [1] and congratulate them on achieving a low complication rate using small intra-aortic balloon pump (IABP) catheters and a sheathless insertion technique.

We agree with Totaro and colleagues that preoperative IABP insertion has been found useful, especially in high risk patients, and sheathless insertion of IABP is associated with a reduced incidence of vascular complications. We also found the sheath to be an important predictor of vascular complications after IABP insertion. Despite technical advances, including wire guided percutaneous insertion, catheters with small diameters and sheathless insertion techniques, use of IABP is still associated with certain complications and various risk factors are associated with the development of these complications. We have used an 8Fr catheter in selected patients, which we did not include in our study because of the small number of patients. Use of a smaller catheter size should logically be associated with a lower incidence of vascular complications after IABP use, though Patel et al. [2] did not find a smaller IABP catheter size to be associated with a lower complications rate. Arafa et al. on the other hand [3] found catheter size to be an independent risk factor for IABP-related major vascular complications. A low incidence of major vascular complications in the experience of Totaro and colleagues might be due to multiple factors, including shorter duration of IABP therapy. The median duration of IABP therapy in their experience was 46 h, while the mean duration in our study was 3.8 days. Prolonged duration of IABP therapy has been shown to be associated with a higher incidence of vascular complications [4,5].

In summary, vascular complications should always be kept in mind while using IABP and we agree with Totaro and colleagues that a smaller sized IABP catheter, using a sheathless insertion technique, should be used to minimize these complications during IABP therapy.

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. Patel J.J., Kopistansky C., Boston B., McBride R., Rzepela A., De Asla R.A., Cohen M. Prospective evaluation of factors associated with intraaortic balloon rupture. ASAIO J 1996;42(1):37-40.[Medline]
  3. Arafa O.E., Pedersen T.H., Svennevig J.L., Fosse E., Geiran O.R. Vascular complications of the intraaortic balloon pump in patients undergoing open heart operations: 15-year experience. Ann Thorac Surg 1999;67(3):645-651.[Abstract/Free Full Text]
  4. Manord J.D., Garrard C.L., Mehra M.R., Sternbergh W.C., 3rd, Ballinger B., Ventura H.O., Stapleton D.D., Smart F.W., Bowen J.C., Money S.R. Implications for the vascular surgeon with prolonged (3 to 89 days) intraaortic balloon pump counterpulsation. J Vasc Surg 1997;26(3):511-516.[Medline]
  5. Iverson L.I., Herfindahl G., Ecker R.R., Young J.N., Ennix C.L., Lee J., Dunning C., Whisenant A., May I.A. Vascular complications of intraaortic balloon counterpulsation. Am J Surg 1987;154(1):99-103.[Medline]




This Article
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