Twenty-four patients required an intra-aortic balloon pump placed through the aortic arch during cardiac operations from 1985 to 1993. The operative procedures of the 24 patients requiring arch balloon pumps included aortocoronary bypass (14), redo aortocoronary bypass (3), valve replacement (3), aortocoronary bypass with concomitant ventricular septal defect repair (1), heart transplantation (2), and aortic to right ventricle fistula repair (1). Mortality was 54%. Morbidity included cerebral vascular accident (17%), acute renal failure (29%), left ventricular thrombus (4%), sternal wound infection (4%), and mediastinal exploration secondary to bleeding from the balloon pump site (4%). This review suggests that (1) mortality for patients requiring arch balloon is significant, (2) complications of cerebral vascular accident and renal failure may be increased, and (3) severe peripheral vascular disease is associated with arch balloon placement and subsequent increased morbidity and mortality.