Intra-Aortic Balloon Pump Insertion

The intra-aortic balloon pump (IABP) is the simplest and most widely used mechanical support for a failing heart. A catheter carrying a long balloon (about 25 to 50 mL, sized to the patient's height) lies in the descending thoracic aorta. Timed to the ECG or arterial pressure, the console fills the balloon with helium as the aortic valve closes, pushing blood back toward the coronary arteries and forward to the body, then empties it just before the heart contracts, so the left ventricle pumps against less resistance. It is used for cardiogenic shock, failure to come off cardiopulmonary bypass after heart surgery, unstable angina or ischemia, mechanical complications of a heart attack, high-risk coronary interventions, and as a bridge to transplant. Most balloons are placed percutaneously through the common femoral artery with a needle, guidewire, dilators and (usually) a sheath, either in the cath lab or in the OR, often at the end of a heart operation when the patient cannot be weaned from bypass. When the femoral arteries are blocked, the balloon can go in through an open femoral cutdown, the axillary artery, or, in the OR after heart surgery, directly into the ascending aorta through a short graft or purse-strings. The tip must sit just below the left subclavian artery and the balloon must end above the renal arteries, which is checked by fluoroscopy, TEE or chest x-ray. The IABP is not used with significant aortic valve leak, aortic dissection or aneurysm, uncontrolled bleeding or sepsis, or severe peripheral vascular disease. The most common complication is loss of blood flow to the leg; others are bleeding, balloon rupture, infection, false aneurysm and nerve injury. The leg below the insertion site is checked often afterward and the patient must not bend it.