Intraaortic balloon pump boon for off-pump coronary artery bypass grafting

Saha, Kamales Kumar; Kaushal, R. P.; Kumar, Ajay; Deval, Mandar; Kaul, Shibban K

doi:10.1177/0218492314544158

Cited by 10 publications

(13 citation statements)

References 9 publications

(14 reference statements)

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“…[73] Saha et al .observed complete revascularization in patients with hemodynamic instability who had an IABP. [74] In a cohort study, data showed no association between IABP insertion and a long-term survival benefit. [75] Zelano et al .…”

Section: Discussionmentioning

confidence: 99%

Intra-aortic balloon pump postcardiac surgery: A literature review

Jannati

Attar

2019

J Res Med Sci

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Intra-aortic balloon pump (IABP) has been the most commonly used mechanical assist circulatory device in many postcardiotomy low output disorders for decades. Mechanism of IABP is based on its inflation in time of the diastolic pressure in the aortic root resulting increase in the blood and oxygen amount of the coronary artery and its deflation in left ventricular afterload during the systolic period. Prophylactic and postoperative application of IABP has been suggested by researchers, which has been commonly used in high-risk patients undertaking coronary artery bypass grafting surgery or percutaneous coronary intervention. Other researchers put forward the idea of the percutaneous IABP insertion throughout the left axillary artery as a reliable and relatively well-tolerated approach and also as a recovery tool to bridge patients with end-stage heart failure to heart transplantation. The current review was aimed to give further insight into routine IABP application by presenting the basic principles and trends in the incidence, management, role of IABP recovery, and long-lasting mortality outcomes in patients with cardiovascular disorders and discussing previous and current evidence.

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Section: Discussionmentioning

confidence: 99%

Intra-aortic balloon pump postcardiac surgery: A literature review

Jannati

Attar

2019

J Res Med Sci

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“…Especially in patients with normal mediastinum on computed tomography and positron emission tomography, we encountered difficulty detecting mediastinal metastases by EBUS-TBNA. Similarly, some recent studies 4,5 have reported that the sensitivity of EBUS-TBNA in patients with radiologically normal mediastinum was lower than that found in previous studies. In particular, the study by Shingyoji and colleagues, 5 reported that the sensitivity of EBUS-TBNA for nodal staging in patients with radiologically normal mediastium was 35%.…”

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confidence: 66%

“…My own limited experience has proved that with an intra-aortic balloon pump as a bailout, it is possible to perform OPCAB without any conversion, and complete revascularization can be easily performed. 5 My colleagues and I compete with the cardiologists, aggressively pursuing multivessel percutaneous coronary intervention, and offer anaortic OPCAB with bilateral ITA grafts as a better alternative in terms of graft patency.…”

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confidence: 99%

High activated clotting time, or venous graft, or off-pump coronary artery bypass grafting? Too early to call off the party!

Saha¹

2015

The Journal of Thoracic and Cardiovascular Surgery

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“…In our technique of OPCAB, IABP was inserted for hemodynamic compromise refractory to inotropic therapy. 6 After routine use of nicorandil infusion, the incidence of IABP during OPCAB decreased to 2.91% from 12.43%. Patients were divided into two groups according to LVEF (Table 4).…”

Section: Resultsmentioning

confidence: 97%

“…5 Various methods have been used to prevent OPCAB conversion to conventional on-pump coronary artery bypass grafting (CABG) including the use of intra-aortic balloon pump (IABP). 6 Nicorandil is an antianginal medicine, 7 and it helps in ischemic preconditioning of the myocardium in addition to dilating epicardial coronary arteries. 8 Prevention of myocardial ischemia during OPCAB is of utmost importance because myocardial ischemia during OPCAB may lead to hemodynamic instability.…”

mentioning

confidence: 99%

Nicorandil Infusion during Off-Pump Coronary Artery Bypass Grafting Reduces Incidence of Intra-aortic Balloon Pump Insertion

Kumar

Deval

Saha

et al. 2016

Innovations�(Phila)

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Objective Off-pump coronary artery bypass grafting in patients with left ventricular dysfunction has proven to be advantageous. However, it carries risk of emergency conversion to cardiopulmonary bypass. We have successfully used an intra-aortic balloon pump to prevent such conversion. The objective of the present study was to evaluate if intravenous nicorandil infusion reduces the incidence of intraoperative intra-aortic balloon pump insertion. Methods Consecutive cases of isolated off-pump coronary artery bypass surgery performed by a single surgeon were studied. Patients were divided into two groups. The first group did not receive nicorandil, and the second group received intraoperative nicorandil infusion (started in the operating room after central line insertion). Results A total of 375 patients were included in the study. Four patients in the non-nicorandil group and the patients in nicorandil group were on preoperative intra-aortic balloon pump and hence excluded from the study. After routine use of nicorandil infusion, incidence of intra-aortic balloon pump insertion during off-pump coronary artery bypass surgery decreased from 12.4% (21/169) to 2.9% (6/206). Conclusions Nicorandil infusion significantly (P = 0.007) reduced the incidence of intra-aortic balloon pump insertion in our series. In patients with left ventricular dysfunction (ejection fraction ≤ 30%), this difference (P = 0.008) assumes a special significance as off-pump bypass surgery is considered high risk in this subset. Nicorandil is an inexpensive drug, and the reduction in cost of surgery by avoiding intra-aortic balloon pump insertion is an added advantage. The use of nicorandil infusion during off-pump coronary artery bypass may result in favorable patient outcomes by reducing invasive intra-aortic balloon pump insertion during off-pump coronary artery bypass grafting.

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Intraaortic balloon pump boon for off-pump coronary artery bypass grafting

Abstract: For treating hemodynamic instability during off-pump coronary artery bypass, we recommend intraaortic balloon pump insertion as the preferred bail-out method rather than conversion to cardiopulmonary bypass.

Cited by 10 publications

References 9 publications

Intra-aortic balloon pump postcardiac surgery: A literature review

Intra-aortic balloon pump postcardiac surgery: A literature review

High activated clotting time, or venous graft, or off-pump coronary artery bypass grafting? Too early to call off the party!

Nicorandil Infusion during Off-Pump Coronary Artery Bypass Grafting Reduces Incidence of Intra-aortic Balloon Pump Insertion

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