Results of intra-aortic balloon pump in patients undergoing coronary artery bypass graft and analysis of risk factors_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Xianqiang , YUAN Xin , WU Hengchao , ZHENG Zhe ,  SUN Hansong

Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

SUN Hansong, Email: shs1505@sina.com

Keywords：

Coronary artery bypass graft; intra-aortic balloon pump; mortality; complication; risk factor

DOI：

10.7507/1007-4848.201712024

Video：

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Objective To analyze the results of intra-aortic balloon pump (IABP) support in patients receiving coronary artery bypass graft (CABG) and the risk factors of postoperative death. Methods The clinical data of 334 patients undergoing CABG procedure and receiving IABP support in Fuwai Hospital from January 1999 to April 2012 were retrospectively analyzed. According to the IABP insertion timing, the patients were divided into three groups: pre-, intra- and postoperative IABP groups. There were 45 males and 11 females aged 60.5±10.7 years in the preoperative IABP group, 84 males and 23 females aged 61.1±8.4 years in the intraoperative IABP group and 119 males and 52 females aged 61.4±8.5 years in the postoperative IABP group.Outcomes of the three groups were compared, including mortality, major complications, ICU stay, hospital stay and total costs. Multivariable logistic regression analysis was used to predict independent risk factors for postoperative in-hospital death. Results The total in-hospital mortality was 16.8% (56/334). Mortality was significantly different among the pre-, intra- and postoperative IABP groups (3.6% vs.23.4%vs. 17.0%, P=0.006). There was no significant difference in complications among the three groups (P=0.960). Multivariable logistic regression analysis indicated that independent risk factors for postoperative mortality included old age (OR=1.05, P=0.040), female (OR=3.34, P<0.001) and increasing left ventricular end-diastolic diameter (LVEDD,OR=1.06, P=0.040). Preoperative IABP support was protective factor (OR=0.10, P=0.050). Conclusion The results of IABP support in CABG patients are satisfactory, and patients with preoperative IABP have a lower mortality. Risk factors for postoperative death include old age, female and increasing LVEDD. Preoperative IABP support is a protective factor.

Citation： WANG Xianqiang, YUAN Xin, WU Hengchao, ZHENG Zhe, SUN Hansong. Results of intra-aortic balloon pump in patients undergoing coronary artery bypass graft and analysis of risk factors. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(6): 495-499. doi: 10.7507/1007-4848.201712024 Copy

1.	Kantrowitz A, Tjonneland S, Freed PS, et al. Initial clinical experience with intraaortic balloon pumping in cardiogenic shock. JAMA, 1968, 203(2): 113-118.
2.	Christenson JT, Cohen M, Ferguson JJ 3rd, et al. Trends in intraaortic balloon counterpulsation complications and outcomes in cardiac surgery. Ann Thorac Surg, 2002, 74(4): 1086-1090.
3.	Padalino MA, Vida VL, Lo Rito M, et al. The role of cardiac surgery in adult patients with congenital heart disease. J Cardiovasc Med (Hagerstown), 2013, 14(5): 326-333.
4.	Baskett RJ, Ghali WA, Maitland A, et al. The intraaortic balloon pump in cardiac surgery. Ann Thorac Surg, 2002, 74(4): 1276-1287.
5.	Igo SR, Hibbs CW, Trono R, et al. Intra-aortic balloon pumping: theory and practice. Experience with 325 patients. Artif Organs, 1978, 2(3): 249-256.
6.	Sanfelippo PM, Baker NH, Ewy HG, et al. Experience with intraaortic balloon counterpulsation. Ann Thorac Surg, 1986, 41(1): 36-41.
7.	Arafa OE, Pedersen TH, Svennevig JL, et al. Intraaortic balloon pump in open heart operations: 10-year follow-up with risk analysis. Ann Thorac Surg, 1998, 65(3): 741-747.
8.	Mannacio V, Di Tommaso L, De Amicis V, et al. Preoperative intraaortic balloon pump for off-pump coronary arterial revascularization. Ann Thorac Surg, 2012, 93(3): 804-809.
9.	Creswell LL, Rosenbloom M, Cox JL, et al. Intraaortic balloon counterpulsation: patterns of usage and outcome in cardiac surgery patients. Ann Thorac Surg, 1992, 54(1): 11-18.
10.	Lavana JD, Fraser JF, Smith SE, et al. Influence of timing of intraaortic balloon placement in cardiac surgical patients. J Thorac Cardiovasc Surg, 2010, 140(1): 80-85.
11.	Parissis H, Leotsinidis M, Akbar MT, et al. The need for intra aortic balloon pump support following open heart surgery: risk analysis and outcome. J Cardiothorac Surg, 2010, 5: 20.
12.	Zangrillo A, Pappalardo F, Dossi R, et al. Preoperative intra-aortic balloon pump to reduce mortality in coronary artery bypass graft: a meta-analysis of randomized controlled trials. Crit Care, 2015, 19: 10.
13.	Santarpino G, Onorati F, Rubino AS, et al. Preoperative intraaortic balloon pumping improves outcomes for high-risk patients in routine coronary artery bypass graft surgery. Ann Thorac Surg, 2009, 87(2): 481-488.
14.	Gong Q, Xing J, Miao N, et al. Beneficial effect of preventative intra-aortic balloon pumping in high-risk patients undergoing first-time coronary artery bypass grafting-a single center experience. Artif Organs, 2009, 33(8): 587-592.
15.	Pilarczyk K, Boening A, Jakob H, et al. Preoperative intra-aortic counterpulsation in high-risk patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials†. Eur J Cardiothorac Surg, 2016, 49(1): 5-17.
16.	Poirier Y, Voisine P, Plourde G, et al. Efficacy and safety of preoperative intra-aortic balloon pump use in patients undergoing cardiac surgery: a systematic review and meta-analysis. Int J Cardiol, 2016, 207: 67-79.
17.	Ranucci M, Castelvecchio S, Biondi A, et al. A randomized controlled trial of preoperative intra-aortic balloon pump in coronary patients with poor left ventricular function undergoing coronary artery bypass surgery. Crit Care Med, 2013, 41(11): 2476-2483.
18.	Rihal CS, Naidu SS, Givertz MM, et al. 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care (Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention). J Card Fail, 2015, 21(6): 499-518.
19.	Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg, 2012, 143(1): 4-34.
20.	StephanWindecker, Kolh P, Alfonso F, et al. 2014 ESC/EACTS guidelines on myocardial revascularization. Rev Esp Cardiol (Engl Ed), 2015, 68(2): 144.
21.	Ramnarine IR, Grayson AD, Dihmis WC, et al. Timing of intra-aortic balloon pump support and 1-year survival. Eur J Cardiothorac Surg, 2005, 27(5): 887-892.
22.	Arafa OE, Pedersen TH, Svennevig JL, et al. Intraaortic balloon pump in open heart operations: 10-year follow-up with risk analysis. Ann Thorac Surg, 1998, 65(3): 741-747.

1. Kantrowitz A, Tjonneland S, Freed PS, et al. Initial clinical experience with intraaortic balloon pumping in cardiogenic shock. JAMA, 1968, 203(2): 113-118.
2. Christenson JT, Cohen M, Ferguson JJ 3rd, et al. Trends in intraaortic balloon counterpulsation complications and outcomes in cardiac surgery. Ann Thorac Surg, 2002, 74(4): 1086-1090.
3. Padalino MA, Vida VL, Lo Rito M, et al. The role of cardiac surgery in adult patients with congenital heart disease. J Cardiovasc Med (Hagerstown), 2013, 14(5): 326-333.
4. Baskett RJ, Ghali WA, Maitland A, et al. The intraaortic balloon pump in cardiac surgery. Ann Thorac Surg, 2002, 74(4): 1276-1287.
5. Igo SR, Hibbs CW, Trono R, et al. Intra-aortic balloon pumping: theory and practice. Experience with 325 patients. Artif Organs, 1978, 2(3): 249-256.
6. Sanfelippo PM, Baker NH, Ewy HG, et al. Experience with intraaortic balloon counterpulsation. Ann Thorac Surg, 1986, 41(1): 36-41.
7. Arafa OE, Pedersen TH, Svennevig JL, et al. Intraaortic balloon pump in open heart operations: 10-year follow-up with risk analysis. Ann Thorac Surg, 1998, 65(3): 741-747.
8. Mannacio V, Di Tommaso L, De Amicis V, et al. Preoperative intraaortic balloon pump for off-pump coronary arterial revascularization. Ann Thorac Surg, 2012, 93(3): 804-809.
9. Creswell LL, Rosenbloom M, Cox JL, et al. Intraaortic balloon counterpulsation: patterns of usage and outcome in cardiac surgery patients. Ann Thorac Surg, 1992, 54(1): 11-18.
10. Lavana JD, Fraser JF, Smith SE, et al. Influence of timing of intraaortic balloon placement in cardiac surgical patients. J Thorac Cardiovasc Surg, 2010, 140(1): 80-85.
11. Parissis H, Leotsinidis M, Akbar MT, et al. The need for intra aortic balloon pump support following open heart surgery: risk analysis and outcome. J Cardiothorac Surg, 2010, 5: 20.
12. Zangrillo A, Pappalardo F, Dossi R, et al. Preoperative intra-aortic balloon pump to reduce mortality in coronary artery bypass graft: a meta-analysis of randomized controlled trials. Crit Care, 2015, 19: 10.
13. Santarpino G, Onorati F, Rubino AS, et al. Preoperative intraaortic balloon pumping improves outcomes for high-risk patients in routine coronary artery bypass graft surgery. Ann Thorac Surg, 2009, 87(2): 481-488.
14. Gong Q, Xing J, Miao N, et al. Beneficial effect of preventative intra-aortic balloon pumping in high-risk patients undergoing first-time coronary artery bypass grafting-a single center experience. Artif Organs, 2009, 33(8): 587-592.
15. Pilarczyk K, Boening A, Jakob H, et al. Preoperative intra-aortic counterpulsation in high-risk patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials†. Eur J Cardiothorac Surg, 2016, 49(1): 5-17.
16. Poirier Y, Voisine P, Plourde G, et al. Efficacy and safety of preoperative intra-aortic balloon pump use in patients undergoing cardiac surgery: a systematic review and meta-analysis. Int J Cardiol, 2016, 207: 67-79.
17. Ranucci M, Castelvecchio S, Biondi A, et al. A randomized controlled trial of preoperative intra-aortic balloon pump in coronary patients with poor left ventricular function undergoing coronary artery bypass surgery. Crit Care Med, 2013, 41(11): 2476-2483.
18. Rihal CS, Naidu SS, Givertz MM, et al. 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care (Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention). J Card Fail, 2015, 21(6): 499-518.
19. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg, 2012, 143(1): 4-34.
20. StephanWindecker, Kolh P, Alfonso F, et al. 2014 ESC/EACTS guidelines on myocardial revascularization. Rev Esp Cardiol (Engl Ed), 2015, 68(2): 144.
21. Ramnarine IR, Grayson AD, Dihmis WC, et al. Timing of intra-aortic balloon pump support and 1-year survival. Eur J Cardiothorac Surg, 2005, 27(5): 887-892.
22. Arafa OE, Pedersen TH, Svennevig JL, et al. Intraaortic balloon pump in open heart operations: 10-year follow-up with risk analysis. Ann Thorac Surg, 1998, 65(3): 741-747.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Results of intra-aortic balloon pump in patients undergoing coronary artery bypass graft and analysis of risk factors

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