Should We Consider the Ethnic Difference in Selecting Size of Intraaortic Balloon by Commercial Guideline?

Abstract

To evaluate the appropriateness of commercial guideline in selecting the size of balloon for intraaortic counterpulsation in Asian patients, we analyzed the relationship between aortic dimensions measured from computed tomography and body indexes. There were 125 patients who underwent the computed tomography. They were divided into three height groups [<152 cm (I), 152-162 cm (II), and 163-183 cm (III)]. Aortic length and diameter were obtained from the origin of left subclavian artery to the orifice of renal artery. We compared those measurements with the balloon size according to the commercial guideline. Aortic lengths were measured as 250 +/- 15 (233-289), 262 +/-16 (227-298), and 285 +/- 19 (239-334) mm in each group, respectively. As the guideline, if we insert the balloon of 25 ml/191 mm, 34 ml/236 mm, and 40 ml/280 mm, there will be 29 of 66 patients (44%) in group III, who have shorter aortic length, with increased risk of obstructing renal artery. In addition, the younger the patient the higher is the risk (p = 0.038). We should pay attention to proper positioning of intraaortic balloon in younger Asian patients with 163-183 cm height, in applying the commercial guideline to prevent renal arterial obstruction.

Visceral Arterial Compromise During Intra-Aortic Balloon Counterpulsation Therapy

“…However, clinical reports of abdominal organ ischemia resulting from anatomic-to-device length mismatch are limited. 18 -20 More recently, Cho et al 21 could demonstrate in their CT study a 29% rate of renal artery compromise in patient heights of 163 to 183 cm when using a 40-mL balloon size. The mismatch was especially common in patients of small stature.…”

“…21,22 Careful survey of the CT scans revealed senile degeneration and sintering of the vertebral bodies in 43% of the patients, which may be contributory to shrinkage of the thoracolumbal backbone and shortening of the longitudinal aortic axis, respectively. Thus, patient height alone appears to be not sufficient to guide for balloon sizing and to avoid anatomic-to-device length mismatch.…”

Intra‐Aortic Balloon Pump Malposition Reduces Visceral Artery Perfusion in an Acute Animal Model

“…From the current literature, it is apparent that an IABP position that is too low is a common clinical finding, but the influence of this malposition on visceral artery perfusion is still unclear . To our knowledge, the present animal study quantifies for the first time a significant impact on visceral artery perfusion that is due solely to an augmenting IABP catheter overlapping the origins of visceral arteries.…”

“…Despite strict adherence to implantation guidelines, frequent malpositioning of the IABP balloon with visceral arterial compromise has been noted on computerized tomographic (CT) scans; this might be induced by a reduced distance from the left subclavian artery to the mesenteric superior artery and a suboptimal placement strategy . Our goal was to determine the influence on the visceral artery blood flow when an IABP compromises the visceral arteries in an acute animal model.…”

A statistical model that predicts the length from the left subclavian artery to the celiac axis; towards accurate intra aortic balloon sizing

“…However, clinical reports of intra-abdominal ischemia due to anatomic-to-device length mismatch are limited [10,11]. Furthermore, Cho et al [12] has published in a CT study a 29% rate of renal artery compromise in patient heights of 163 to 183 cm when using a 40-mL balloon size, especially in patients with a small stature. In our study, we confirm by enlarge, these findings: there is only a varying correlation between height and aortic length, which is influenced by age, sex, and possibly ethnic differences [12].…”