Efficacy and cost-effectiveness of preoperative IABP in patients with ejection fraction of 0.25 or less

Dietl, Charles A.; Berkheimer, Marie D.; Woods, Edward; Gilbert, Clare; Pharr, William F.; Benoit, Charles

doi:10.1016/0003-4975(96)00244-5

Cited by 143 publications

(75 citation statements)

References 24 publications

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“…Other major complications associated with the use of IABP include aortic dissection, paraplegia, bacteremia, mesenteric infarction, balloon rupture, and balloon entrapment [17] [18].…”

Section: Discussionmentioning

confidence: 99%

Role of Intra-Aortic Balloon Pump in Off-Pump Coronary Artery Bypass <br/>—A Vettath Modification

Vettath¹,

Vellachamy²,

Gangadharan³

et al. 2016

WJCD

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Objective: Hemodynamic deterioration during positioning of the heart has been the most critical complication of off-pump coronary artery bypass surgery. Pre-operative use of intra-aortic balloon pump has been shown to prevent this complication in high risk patients. The role of balloon pump in high risk patients has been questioned by our group. We modified the role of balloon pump in our patients, thus avoiding the conversion to cardiopulmonary bypass. Methods: 4063 off-pump coronary bypass surgeries were performed by a single surgeon in our center, over thirteen years. 130 intra-aortic balloons used between July 2002 and December 2015 were removed from the theater, once the distal anastomosis was performed. We studied this group of patients for-time and need for insertion, duration of balloon used, local insertion problems and survival. Results: Initially, we inserted intra-aortic balloons in high risk patients. We observed that, patients with low ejection fraction and patients with critical left main coronary artery disease were not the ones who actually needed balloon pump support. It was the patients who had ongoing ischemia, with preserved left ventricular function, and ST depression intra-operatively, who needed balloon pump support to perform complete anatomical revascularization. Conclusions: Intra-aortic balloon pump has helped us to position the heart without hemodynamic instability, thereby avoiding conversion to cardiopulmonary bypass. This enabled us to perform off-pump surgery in virtually all areas of the heart, thus maintaining perfect hemodynamics.

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“…Other major complications associated with the use of IABP include aortic dissection, paraplegia, bacteremia, mesenteric infarction, balloon rupture, and balloon entrapment [17] [18].…”

Section: Discussionmentioning

confidence: 99%

Role of Intra-Aortic Balloon Pump in Off-Pump Coronary Artery Bypass <br/>—A Vettath Modification

Vettath¹,

Vellachamy²,

Gangadharan³

et al. 2016

WJCD

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“…For example, early initiation of continuous or intermittent renal replacement therapy in patients with evidence of preoperative renal dysfunction have shown improved outcomes in small studies. 23,24 The need for a VAD showed a risk reduction for a prolonged ICU stay, which might seem illogical. However, a relatively short ICU stay in VAD patients is due to the early and high mortality rate in this population.…”

Section: Discussionmentioning

confidence: 99%

Intensive Care Unit Stay of More than 14 Days after Cardiac Surgery is Associated with Non-cardiac Organ Failure

et al. 2006

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Some studies have shown an association between a prolonged intensive care unit (ICU) stay and risk factors such as mediastinal re-exploration, advanced age, low ejection fraction, lung disease and organ failure. The aim of this retrospective study was first to evaluate peri-operative risk factors (n = 2683) and secondly to evaluate long-term survival (n = 2563) in cardiac surgery patients with an ICU stay > 14 days. Long-term survival was assessed in an observational 3-year follow-up study. An ICU stay of > 14 days was associated independently with respiratory failure and dialysis-dependent acute renal failure, and with a significantly lower survival rate. Since an ICU stay is associated with a higher hospital and long-term mortality, measures should be taken throughout the entire hospital stay to identify and reduce the risk of organ failure.

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“…A number of published studies have expanded the potential clinical applications of IABP, to include high risk patients who undergo CABG. 16,17 Dietl et al undertook a 5-year retrospective analysis of 163 consecutive CABG patients with severe ventricular dysfunction (EF <25%). 18 Thirty-seven patients had received IABP support preoperatively, while 126 did not.…”

Section: Discussionmentioning

confidence: 99%

Early and Mid-Term Impacts of Cardiopulmonary Bypass on Coronary Artery Bypass Grafting in Patients With Poor Left Ventricular Dysfunction A Propensity Score Analysis

Youn

Chang

Hong

et al. 2007

Circ J

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ff-pump coronary artery bypass grafting (OPCAB) is an alternative to conventional cardiopulmonary bypass-supported myocardial revascularization and is becoming increasingly popular, as it allows complete myocardial revascularization with excellent surgical results in most patients. 1,2 Severe left ventricular dysfunction has been reported to be an independent predictor of operative mortality in patients undergoing coronary artery bypass grafting (CABG) and patients with impaired left ventricular function undergoing revascularization on cardiopulmonary bypass (CPB) have increased mortality and morbidity when compared with patients with normal left ventricular function. [3][4][5] Left ventricular dysfunction also often leads to low cardiac output and a high postoperative morbidity, with many patients requiring inotropic or mechanical support, and vasopressors for hours to days after surgery. 6 It has been speculated that extracorporeal circulation may exacerbate myocardial damage in compromised left ventricles as a result of the activation of inflammatory mediators, the non-physiologic ventricular geometry of the empty heart impeding collateral flow to ischemic areas and worsened preservation of interventricular septal movement. 7,8 It may seem advisable to avoid cardiopulmonary bypass in patients with severe left ventricular dysfunction; however, many surgeons still choose conventional CABG using a CPB machine (On-pump CABG) due to hemodynamic instability concerns such as ventricular arrhythmia, hypotension and cardiac arrest during OPCAB. The present study evaluates the effects of cardiopulmonary bypass and the efficacy of OPCAB by comparing the short and mid term results of OPCAB and On-pump CABG in patients with severe left ventricular dysfunction with an analysis of a propensity score matching. Methods Patient SelectionFrom December 2000 through November 2005, 1,473 patients underwent isolated CABG without a concomitant operation-such as left ventricular volume reduction surgery, arrhythmia operation or valve surgery-at Yonsei Cardiovascular Center, Yonsei University College of Medicine. Preoperative and postoperative data were obtained using a Circ J 2007; 71: 1387 -1394 (Received March 8, 2007 revised manuscript received May 9, 2007; accepted June 5, 2007) Department of Thoracic Early and mid-term outcomes of off-pump coronary artery bypass grafting (OPCAB) vs on-pump coronary artery bypass grafting (On-pump CABG) were compared in patients with poor left ventricular dysfunction, using an analysis of a propensity score matching. Methods and ResultsBetween December 2000 and November 2005, 1,473 patients underwent isolated coronary artery bypass grafting in our institute and 153 patients who had a left ventricular ejection fraction (LVEF) lower than 35% were enrolled. The OPCAB group contained 100 patients and the On-pump CABG group contained 53 patients. Preoperative risk factors were compared and 50 patients in each group were matched. The mean follow-up time was 35.5±17.3 months. Three deaths (3.0%...

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Efficacy and cost-effectiveness of preoperative IABP in patients with ejection fraction of 0.25 or less

Cited by 143 publications

References 24 publications

Role of Intra-Aortic Balloon Pump in Off-Pump Coronary Artery Bypass <br/>—A Vettath Modification

Role of Intra-Aortic Balloon Pump in Off-Pump Coronary Artery Bypass <br/>—A Vettath Modification

Intensive Care Unit Stay of More than 14 Days after Cardiac Surgery is Associated with Non-cardiac Organ Failure

Early and Mid-Term Impacts of Cardiopulmonary Bypass on Coronary Artery Bypass Grafting in Patients With Poor Left Ventricular Dysfunction A Propensity Score Analysis

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Efficacy and cost-effectiveness of preoperative IABP in patients with ejection fraction of 0.25 or less

Cited by 143 publications

References 24 publications

Role of Intra-Aortic Balloon Pump in Off-Pump Coronary Artery Bypass &lt;br/&gt;—A Vettath Modification

Role of Intra-Aortic Balloon Pump in Off-Pump Coronary Artery Bypass &lt;br/&gt;—A Vettath Modification

Intensive Care Unit Stay of More than 14 Days after Cardiac Surgery is Associated with Non-cardiac Organ Failure

Early and Mid-Term Impacts of Cardiopulmonary Bypass on Coronary Artery Bypass Grafting in Patients With Poor Left Ventricular Dysfunction A Propensity Score Analysis

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Role of Intra-Aortic Balloon Pump in Off-Pump Coronary Artery Bypass <br/>—A Vettath Modification

Role of Intra-Aortic Balloon Pump in Off-Pump Coronary Artery Bypass <br/>—A Vettath Modification