Management of an Unusual Type of Intra-Aortic Balloon Pump Dysfunction

A 59-year-old man underwent placement of an intra-aortic balloon pump (IABP) in anticipation of coronary artery bypass graft surgery. While the patient was in the cardiac catheterization laboratory, the IABP malfunctioned. Attempts to advance a 0.025-inch guidewire through the IABP guidewire lumen were unsuccessful (the wire entered the IABP helium chamber, arrow, panel A). We were unable to withdraw the IABP (arrow, panel B) through the femoral arterial sheath (arrowhead, panel B). We subsequently cut the proximal portion of the IABP catheter and exposed the metal guidewire tube (arrow, panel D). The tube was partially collapsed at the incision point, not allowing insertion of a 0.025- or 0.014-inch guidewire. Using an 18 gauge needle we enlarged the proximal orifice of the cut metal tube, allowing insertion of a 0.014-inch Confianza Pro 12 guidewire (Abbott Vascular) that remained in the guidewire lumen and entered the aorta (panel C). The damaged IABP was removed together with the femoral sheath (arrowheads, panel E), and a new sheath and IABP were inserted without complications.

Our case highlights an unusual IABP complication. Most reported IABP failures are related to blood entered into the helium chamber.¹ In our case a communication was created between the IABP lumen and the helium gas lumen, not allowing advancement of a guidewire through the dysfunctional IABP. Removing the IABP would also require removing the femoral arterial sheath, which carried high risk, in an already anticoagulated patient. Cutting the IABP catheter allowed exposure of the guidewire lumen followed by successful insertion of a 0.014-inch guidewire and removal of the damaged IABP, while maintaining arterial access. This complication was reported to the IABP manufacturer that subsequently issued a recall of the devices due to increased reports of IABP getting “stuck in sheath”.

Awareness of the IABP design can allow development of creative solutions in cases of IABP malfunction.

References

1. Horowitz MD, Otero M, de Marchena EJ, Neibart RM, Novak S, Bolooki H. Intraaortic balloon entrapment. Ann Thorac Surg 1993;56:368-370.

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From the VA North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas.
Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr. Papayannis reported no conflicts regarding the content herein. Dr. Banerjee reported speaker honoraria from St. Jude Medical, Medtronic, and Johnson & Johnson and research support from Boston Scientific and The Medicines Company. Dr. Brilakis reported speaker honoraria from St. Jude Medical and Terumo; consulting fees from Medicure; research support from Abbott Vascular and InfraRedx; and salary from Medtronic (spouse).
Manuscript submitted March 2, 2011, provisional acceptance given April 18, 2011, final version accepted April 28, 2011.
Address for correspondence: Emmanouil S. Brilakis, MD, PhD, VA North Texas Health Care System, The University of Texas Southwestern Medical Center at Dallas, Division of Cardiology (111A), 4500 S. Lancaster Rd., Dallas, TX 75216. Email: esbrilakis@yahoo.com