Preoperative intra-aortic counterpulsation in high-risk patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials

Pilarczyk, Kevin; Boening, Andreas; Jakob, Heinz; Langebartels, Georg; Markewitz, Andreas; Haake, Nils; Heringlake, Matthias; Trummer, Christian

doi:10.1093/ejcts/ezv258

Cited by 63 publications

(40 citation statements)

References 33 publications

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“…As a consequence, further evidence in support of a given intervention has become available since the last web vote. In particular, recent meta-analyses reported a survival benefit associated with use volatile agents in cardiac (but not in non-cardiac) surgery, 65 and perioperative hemodynamic optimization, 66 and pre-operative IABP 67 were also associated with benefits.…”

Section: New Evidencementioning

confidence: 99%

Randomized Evidence for Reduction of Perioperative Mortality: An Updated Consensus Process

Landoni

Pisano

Lomivorotov

et al. 2017

Journal of Cardiothoracic and Vascular Anesthesia

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Of the 230 million patients undergoing major surgical procedures every year, more than 1 million will die within 30 days. Thus, any nonsurgical interventions that help reduce perioperative mortality might save thousands of lives. The authors have updated a previous consensus process to identify all the nonsurgical interventions, supported by randomized evidence, that may help reduce perioperative mortality

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Section: New Evidencementioning

confidence: 99%

Randomized Evidence for Reduction of Perioperative Mortality: An Updated Consensus Process

Landoni

Pisano

Lomivorotov

et al. 2017

Journal of Cardiothoracic and Vascular Anesthesia

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“…Although previous reports have shown conflicting results for preoperative IABP insertion in high-risk patients undergoing surgical revascularization121314151617181920, the evidence from several meta-analyses support preoperative IABP insertion for high-risk patients121417. Unfortunately, these meta-analysis studies included few OPCAB patients.…”

mentioning

confidence: 99%

Preoperative intra-aortic balloon pump improves the clinical outcomes of off-pump coronary artery bypass grafting in left ventricular dysfunction patients

Feng

Wang

Hou

et al. 2016

Sci Rep

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Severe left ventricular (LV) dysfunction patients undergoing off-pump coronary artery bypass grafting (OPCAB) are often associated with a higher mortality. The efficacy and safety of the preoperative prophylactic intra-aortic balloon pump (IABP) insertion is not well established. 416 consecutive patients with severe LV dysfunction (ejection fraction ≤35%) undergoing isolated OPCAB were enrolled in a retrospective observational study. 191 patients was enrolled in the IABP group; the remaining 225 patients was in control group. A total of 129 pairs of patients were propensity-score matched. No significant differences in demographic and preoperative risk factors were found between the two groups. The postoperative 30-day mortality occurred more frequently in the control group compared with the IABP group (8.5% vs. 1.6%, p = 0.02). There was a significant reduction of low cardiac output syndrome in the IABP group compared with the control group (14% vs. 6.2%, p = 0.04). Prolonged mechanical ventilation (≥48 h) occurred more frequently in the control group (34.9% vs. 20.9%, p = 0.02). IABP also decreased the postoperative length of stay. Preoperative IABP was associated with a lower 30-day mortality, suggesting that it is effective in patients with severe LV dysfunction undergoing OPCAB.

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“…Yet IABP application is in general an invasive procedure that might be associated with some adverse effects like limb ischemia and arterial dissection. [14] On the other hand the coasts of Levosimendan infusion and insertion of an IABP set are similar and the increased coasts of preoperative admission to ICU for one day to receive the infusion are compensated postoperatively if the patient needed IABP which will remain for at least 48 hours before being removed.…”

Section: Discussionmentioning

confidence: 99%

Effect of Levosimendan Infusion 24 Hours Before CABG Surgery in Patients with Impaired Left Ventricular Function on the Need for Postoperative IABP

Nasr¹,

Alkady²,

Saber³

et al. 2019

IJCTS

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Background: Due to their unfavorable outcome, patients with impaired left ventricular function undergoing CABG surgery (LVEF ≤ 35%) are in a real need for optimization of their preoperative status in order to achieve the best possible results. In this retrospective comparative study we analysis our results in patients with impaired LV function after using Levosimendan as a continuous infusion 24 hours prior to CABG surgery regarding the need for postoperative IABP. Patients and methods: We included in this study 103 patients with LVEF ≤ 35% that underwent coronary artery bypass grafting with or without repair of ischemic mitral regurgitation and received Levosimendan infusion 24 hours before surgery in the period between January 2016 and January 2019 in 2 hospitals (Group A). These data were compared to another matched control group of 98 patients with similar conditions that were operated in the same hospitals over a previous period of 3 years but received no Levosimendan infusion preoperatively (Group B). Results: There was a statistically significant difference in the postoperative results in favor of group A regarding the need for IABP application (P-value = 0.013). However there were no statistically significant differences between both groups in concern of duration of inotropic support (P-value = 0.40), duration of mechanical ventilation (P-value = 0.30), total ICU (P-value = 0.20) and hospital stays (P-value = 0.40), incidence of postoperative atrial fibrillation (P-value = 0.50), incidence of major adverse effects, and in-hospital mortality (P-value = 0.20). There was only one in-hospital mortality in each group. Conclusion: According to our study, infusion of Levosimendan 24 hours prior to CABG surgery in patients with impaired left ventricular contractility is safe and effective in reducing the need of IABP application. However Levosimendan infusion did not affect significantly postoperative coarse, incidence of major adverse effects, and in-hospital mortality.

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Preoperative intra-aortic counterpulsation in high-risk patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials

Cited by 63 publications

References 33 publications

Randomized Evidence for Reduction of Perioperative Mortality: An Updated Consensus Process

Randomized Evidence for Reduction of Perioperative Mortality: An Updated Consensus Process

Preoperative intra-aortic balloon pump improves the clinical outcomes of off-pump coronary artery bypass grafting in left ventricular dysfunction patients

Effect of Levosimendan Infusion 24 Hours Before CABG Surgery in Patients with Impaired Left Ventricular Function on the Need for Postoperative IABP

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