Pre-operative intra aortic balloon pumps in patients undergoing coronary artery bypass grafting

Theologou, Thomas; Bashir, Mohamad; Rengarajan, Arvind; Khan, Omar; Spyt, Tom; Richens, David; Field, Mark

doi:10.1002/14651858.cd004472.pub3

Cited by 61 publications

(45 citation statements)

References 32 publications

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“…1021 In contrast, its routine use in subjects who are not thought to be high risk has not been demonstrated. 1027 Some myocyte necrosis often occurs during and immediately after CABG, caused by cardiac manipulation, inadequate myocardial protection, intraoperative defibrillation, or acute graft failure. A determination of the frequency and magnitude with which postoperative myonecrosis occurs has been difficult.…”

Section: Classmentioning

confidence: 99%

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

et al. 2011

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Section: Classmentioning

confidence: 99%

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

et al. 2011

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“…Nevertheless, studies also reported that no survival advantage was found in the prophylactic application of an IABP in hemodynamically stable, high-risk patients undergoing bypass grafting, as opposed to the placement of an IABP on an as-needed basis during or after surgery [7,8]. Although the practicability of an IABP has been extensively investigated in the past 3 decades, the timing of application of an IABP remained uncertain in high-risk patients undergoing OPCABG [21,22]. In this study, patients in the IABP group had significantly lower incidence rates of postoperative LCOS, and respiratory as well as renal failure compared to patients in the control group, which indicates that preincision use of an IABP helped to preserve the cardiopulmonary and renal function.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Application of an Intra-Aortic Balloon Pump in High-Risk Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Ding

Wei

et al. 2015

Cardiology

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Background: An intra-aortic balloon pump (IABP) is the most commonly used circulatory assist device in cardiac surgery. We hypothesized that prophylactic application of an IABP improves early clinical outcome of high-risk patients undergoing scheduled off-pump coronary artery bypass grafting (OPCABG). Methods: From January 2010 to December 2013, hemodynamically stable, high-risk patients undergoing scheduled OPCABG with preincision use of an IABP were recruited to the IABP group. Using the propensity score-matching method, every patient in the IABP group was matched with another patient (the control group) with a similar propensity score who received an IABP on an as-needed basis during or after OPCABG. Surgical mortality and major morbidity rates were compared between groups. Results: A total of 116 patient pairs were included in this study. In patients in the IABP group, postoperative low cardiac output and respiratory as well as renal failure were less frequent, intensive care unit stay was shorter, and surgical mortality was lower compared to patients in the control group. In multivariate logistic regression, timing of IABP implantation, as an independent risk factor, was associated with postoperative low cardiac output (OR = 2.02, 95% CI 1.28-5.76), respiratory failure (OR = 1.86, 95% CI 1.19-4.27), renal failure (OR = 2.96, 95% CI 1.51-6.63) and surgical mortality (OR = 2.45, 95% CI 1.42-6.07). Conclusions: Prophylactic application of an IABP improves postoperative cardiac performance, reduces respiratory and renal complications, and consequently lowers surgical mortality in high-risk patients undergoing scheduled OPCABG.

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“…The definition of "high risk" varies between these studies and include older age, low ejection fraction or symptomatic congestive heart failure, injury to the ECA, the second CABG surgery or urgent / emergency [11]. In recent Cochrane meta-analysis [33] observed that the evidence suggests that preoperative IABP may have beneficial effect on mortality and morbidity in specific high-risk groups undergoing CABG, however, there are many problems with the quality , reliability and validity of the tests. The available evidence is not robust enough to extend the use of the IABP for elective high-risk patients: define more precisely which groups of patients who may benefit will be the challenge for the future.…”

Section: Discussionmentioning

confidence: 99%

Use of intra-aortic balloon pump in cardiac surgery: analysis of 80 consecutive cases

Júnior¹,

Tagliari²,

Luvizetto³

et al. 2012

Rev Bras Cir Cardiovasc

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Background:The low cardiac output syndrome in perioperative period of cardiac surgery may occur in about 10 to 15% of patients; of this total, 2% require mechanical support for adequate hemodynamic control.Objective: This study aimed to describe the mortality of patients requiring intra-aortic balloon pump (IABP) in transor post-cardiac surgery, identifying preoperative variables associated with a worse outcome, as well as describe the postoperative complications and survival in the medium term. Patients and Methods: retrospective cohort study including 80 consecutive cases between January/2009 and September/ 2011. The patients had on average 62.9 ± 11.3 years and 58.8% were male. In the sample, 81.3% were hypertensive, 50% had previous myocardial infarction and 38.8% heart failure NYHA III/IV. The most common surgery performed was isolated coronary artery bypass grafting (37.5%).Results: Hospital mortality was 53.8% (95% HF: 42.7-64.9) and the cross-clamp time >90 minutes was an independent predictor of mortality in multivariate analysis (RR 1.52 95% HF: 1.04-2.22). Regarding complications, 71.3% (95% HF: 61.2 to 81.4) of patients had at least one additional complication: the lower limb ischemia was observed in 5.0% of patients. The 1-year survival was 43.6%, observing a plateau in the survival rate after an initial sharp drop, related to hospital mortality.Conclusion: Patients who need the IABP form a group of very high risk for morbidity and mortality. Its use, however, allows many patients to recover an evolution that was invariably fatal, having the patients discharged home a good survival in the medium term.Descriptors: Intra-aortic balloon pumping. Cardiac surgical procedures. Cardiac output, low. ResumoFundamento: A síndrome de baixo débito cardíaco no perioperatório de cirurgia cardíaca pode incidir em cerca de 10 a 15% dos pacientes; desse total, 2% necessitam de suporte mecânico para adequado controle hemodinâmico.Objetivos: Descrever a mortalidade de pacientes que necessitaram utilizar balão intra-aórtico (BIAo) no trans ou pós-operatório de cirurgia cardíaca, identificando variáveis pré-operatórias associadas a pior desfecho, assim como descrever as complicações pós-operatórias e a sobrevida em médio prazo. Rev Bras Cir Cardiovasc 2012;27(2):251-9

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Pre-operative intra aortic balloon pumps in patients undergoing coronary artery bypass grafting

Cited by 61 publications

References 32 publications

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

Prophylactic Application of an Intra-Aortic Balloon Pump in High-Risk Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Use of intra-aortic balloon pump in cardiac surgery: analysis of 80 consecutive cases

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