Complications of the intraaortic balloon counterpulsation device: Clinical and morphologic observations in 45 necropsy patients

Of 45 patients who died after insertion of an intraaortic balloon assist device and who were studied at necropsy, 16 (36 percent) were found to have one or more complications (total 20) related to use of the device. The 20 complications consisted of dissection of the aorta or its distal branches, or both (9), arterial perforation (3), arterial thrombi (3), arterial emboli (3), limb ischemia (1) and local wound infection (1). Of the nine cases of arterial dissection, none were diagnosed or suspected before necropsy. Of the entire 20 complications, only 4 (20 percent) were suspected before death. Although the operating team frequently encountered no difficulty at the time of insertion of the device, 12 of the 20 complications were a direct result of insertion of the intraaortic balloon assist device. In two patients in whom insertion of the balloon caused dissection of the aorta, hemodynamic improvement occurred for 2 and 3 days, respectively, even though the “intraaortic” balloon (as well as the catheter) was not located in the true lumen of the aorta. Thus, clinical evaluation of complications related to use of the intraaortic balloon assist device underestimates their frequency. Most complications are consequences of insertion of the device, not consequences of its being in place.