Application of Intra-aortic Balloon Pump for High-risk Patients before Off-pump Coronary Artery Bypass Grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DING Wenjun , WEI Qiang , SUN Yongxin , SHI Yunqing , WANG Chunsheng.

Department of Cardiovascular Surgery， Shanghai Institute of Cardiovascular Diseases， Zhongshan Hospital， Fudan University， Shanghai 200032， P. R. China;

Corresponding author：

Keywords：

Intra-aortic balloon pump; 　High risk; 　Off-pump coronary artery bypass grafting

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Abstract： Objective To analyze clinical outcomes of intra-aortic balloon pump （IABP） application for high-risk　 patients before undergoing off-pump coronary artery bypass grafting （OPCAB）， and summarize our experience and weaning indications of IABP. Methods We retrospectively analyzed clinical data of 102 high-risk patients with coronary artery disease who underwent IABP implantation before OPCAB from January 2008 to July 2011 in Zhongshan Hospital of Fudan University. There were 71 male patients and 31 female patients with their average age of 63.0±8.2 years in this IABP group. We also chose another 100 patients without IABP implantation before undergoing OPCAB as the control group， including 55 male patients and 45 female patients with their average age of 64.1±9.5 years. Postoperative systolic arterial blood pressure （SABP）， mean arterial blood pressure （MABP）， mechanical ventilation time， length of intensive care unit（ICU） stay， morbidity， duration of IABP treatment and in-hospital mortality of two groups were compared. Left ventricular　 ejection fraction （LVEF） was evaluated with echocardiography 3 months after surgery. Results Postoperative SABP （95.3±12.2 mm Hg vs. 80.1±11.7 mm Hg；t=8.440， P=0.000） and MABP （78.9±13.5 mm Hg vs. 52.3±15.1 mm Hg； t=12.410， P=0.000） of the IABP group were significantly higher than those of the control group. Mechanical ventilation time， length of ICU stay and duration of inotropic support of the IABP group were significantly shorter than those of the control group. The incidence of ventricular arrhythmia， low cardiac output syndrome， perioperative myocardial infarction and dialysis-requiring acute kidney failure of the IABP group were significantly lower than those of the control group. In-hospital mortality of the IABP group was significantly lower than that of the control group ［5.9% （6/102） vs. 17.0% （17/100）， χ 2 =6.180， P=0.020］. Ninety-six patients in the IABP group and 83 patients in the control group were followed up for 3 months. Three months after surgery， echocardiography showed that LVEF of the IABP group was significantly higher than that of the control group（45.3%±12.0% vs. 39.1%±8.2%， t=3.950， P=0.000）. Conclusion Preoperative prophylactic IABP implantation and optimal timing of weaning from IABP support can not only significantly reduce surgical risk and improve surgical outcomes and postoperative recovery of high-risk patients undergoing OPCAB， but also considerably ameliorate patient heart function and reduce perioperative morbidity and mortality.

Citation： DING Wenjun,WEI Qiang,SUN Yongxin,SHI Yunqing,WANG Chunsheng.. Application of Intra-aortic Balloon Pump for High-risk Patients before Off-pump Coronary Artery Bypass Grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(1): 10-14. doi: Copy

1.	Yokoyama T， Baumgartner FJ， Gheissari A， et al. Off-pump versus on-pump coronary bypass in high-risk subgroups. Ann Thorac Surg， 2000， 70 （5）：1546-1550.
2.	Do QB， Goyer C， Chavanon O， et al. Hemodynamic changes during off-pump CABG surgery. Eur J Cardiothorac Surg， 2002， 21 （3）：385-390.
3.	Edgerton JR， Dewey TM， Magee MJ， et al. Conversion in off-pump　 coronary artery bypass grafting：an analysis of predictors and outcomes. Ann Thorac Surg， 2003， 76 （4）：1138-1142.
4.	Allie DE， Lirtzman M， Malik AP， et al. Rapid-staged strategy for concomitant critical carotid and left main coronary disease with left ventricular dysfunction：IABP use. Ann Thorac Surg， 1998， 66 （4）：1230-1235.
5.	Miceli A， Duggan SM， Capoun R， et al. A clinical score to predict the need for intraaortic balloon pump in patients undergoing coronary artery bypass grafting. Ann Thorac Surg， 2010， 90 （2）：522-526.
6.	Dyub AM， Whitlock RP， Abouzahr LL， et al. Preoperative intra-aortic balloon pump in patients undergoing coronary bypass surgery：a systematic review and meta-analysis. J Card Surg， 2008， 23 （1）：79-86.
7.	Ranucci M， Ballotta A， Castelvecchio S， et al. Perioperative heart failure in coronary surgery and timing of intra-aortic balloon pump insertion. Acta Anaesthesiol Scand， 2010， 54 （7）：878-884.
8.	Diez C， Silber RE， Wächner M， et al. EuroSCORE directed intraaortic balloon pump placement in high-risk patients undergoing cardiac surgery——retrospective analysis of 267 patients. Interact Cardiovasc Thorac Surg， 2008， 7 （3）：389-395.
9.	Bonios MJ， Pierrakos CN， Argiriou M， et al. Increase in coronary blood flow by intra-aortic balloon counterpulsation in a porcine model of myocardial reperfusion. Int J Cardiol， 2010， 138 （3）：253-260.
10.	Baskett RF， William AG， Maitland A， et al. The intraaortic balloon pump in cardiac surgery. Ann Thorac Surg， 2002， 74 （4）：1276-1287.
11.	Cartier R， Brann S， Dagenais F， et al. Systematic off-pump coronary artery revascularization in multivessel disease：experience of three hundred cases. J Thorac Cardiovasc Surg， 2000， 119 （2）：221-229.
12.	Gulcan O， Turkoz R， Turkoz A， et al. On-pump/beating-heart myocardial protection for isolated or combined coronary artery bypass grafting in patients with severe left ventricle dysfunction：assessment of myocardial function and clinical outcome. Heart Surg Forum， 2005， 8 （3）：E178-E182.
13.	陈德海，单根法，王宜青，等．非体外循环冠状动脉旁路移植术后左心功能不全的治疗．中国胸心血管外科临床杂志， 2007， 14 （5）：392-393．.
14.	Kacila M， Granov N， Mujci? E， et al. IABP and off pump revascularization as prefered method in curement of patients with “low cardiatic output” syndrome. Med Arh， 2006， 60 （3）：205-206.
15.	Buffolo E， Branco JN， Gerola LR， et al. Off-pump myocardial revascularization：critical analysis of 23 years' experience in 3， 866 patients. Ann Thorac Surg， 2006， 81 （1）：85-89.
16.	Gong QC， Xing JL， 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.
17.	肖雅琼，杜心灵，孙宗全，等．主动脉内球囊反搏在冠状动脉旁路移植术围术期的应用．中国胸心血管外科临床杂志， 2007， 14 （3）：228-229．.
18.	Pérez Vela JL， Martín Benítez JC， Carrasco González M， et al. Clinical practice guide for the management of low cardiac output syndrome in the postoperative period of heart surgery. Med Intensiva， 2012， 36 （4）：e1-e44.
19.	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.
20.	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.
21.	Theologou T， Bashir M， Rengarajan A， et al. Preoperative intraaortic balloon pumps in patients undergoing coronary artery bypass grafting. Cochrane Database Syst Rev， 2011， 19 （1）：CD004472.
22.	Moon C. Preoperative intra-aortic balloon pumping in high-risk cardiac surgery patients. Dimens Crit Care Nurs， 2012， 31 （4）：223-227.
23.	Davidson J， Baumgariner F， Omari B， et al. Intra-aortic balloon pump:indications and complications. J Natl Med Assoc， 1998， 90 （3）：137-140.

1. 　Yokoyama T， Baumgartner FJ， Gheissari A， et al. Off-pump versus on-pump coronary bypass in high-risk subgroups. Ann Thorac Surg， 2000， 70 （5）：1546-1550.
2. 　Do QB， Goyer C， Chavanon O， et al. Hemodynamic changes during off-pump CABG surgery. Eur J Cardiothorac Surg， 2002， 21 （3）：385-390.
3. 　Edgerton JR， Dewey TM， Magee MJ， et al. Conversion in off-pump　 coronary artery bypass grafting：an analysis of predictors and outcomes. Ann Thorac Surg， 2003， 76 （4）：1138-1142.
4. 　Allie DE， Lirtzman M， Malik AP， et al. Rapid-staged strategy for concomitant critical carotid and left main coronary disease with left ventricular dysfunction：IABP use. Ann Thorac Surg， 1998， 66 （4）：1230-1235.
5. 　Miceli A， Duggan SM， Capoun R， et al. A clinical score to predict the need for intraaortic balloon pump in patients undergoing coronary artery bypass grafting. Ann Thorac Surg， 2010， 90 （2）：522-526.
6. 　Dyub AM， Whitlock RP， Abouzahr LL， et al. Preoperative intra-aortic balloon pump in patients undergoing coronary bypass surgery：a systematic review and meta-analysis. J Card Surg， 2008， 23 （1）：79-86.
7. 　Ranucci M， Ballotta A， Castelvecchio S， et al. Perioperative heart failure in coronary surgery and timing of intra-aortic balloon pump insertion. Acta Anaesthesiol Scand， 2010， 54 （7）：878-884.
8. 　Diez C， Silber RE， Wächner M， et al. EuroSCORE directed intraaortic balloon pump placement in high-risk patients undergoing cardiac surgery——retrospective analysis of 267 patients. Interact Cardiovasc Thorac Surg， 2008， 7 （3）：389-395.
9. 　Bonios MJ， Pierrakos CN， Argiriou M， et al. Increase in coronary blood flow by intra-aortic balloon counterpulsation in a porcine model of myocardial reperfusion. Int J Cardiol， 2010， 138 （3）：253-260.
10. 　Baskett RF， William AG， Maitland A， et al. The intraaortic balloon pump in cardiac surgery. Ann Thorac Surg， 2002， 74 （4）：1276-1287.
11. 　Cartier R， Brann S， Dagenais F， et al. Systematic off-pump coronary artery revascularization in multivessel disease：experience of three hundred cases. J Thorac Cardiovasc Surg， 2000， 119 （2）：221-229.
12. 　Gulcan O， Turkoz R， Turkoz A， et al. On-pump/beating-heart myocardial protection for isolated or combined coronary artery bypass grafting in patients with severe left ventricle dysfunction：assessment of myocardial function and clinical outcome. Heart Surg Forum， 2005， 8 （3）：E178-E182.
13. 　陈德海，单根法，王宜青，等．非体外循环冠状动脉旁路移植术后左心功能不全的治疗．中国胸心血管外科临床杂志， 2007， 14 （5）：392-393．.
14. 　Kacila M， Granov N， Mujci? E， et al. IABP and off pump revascularization as prefered method in curement of patients with “low cardiatic output” syndrome. Med Arh， 2006， 60 （3）：205-206.
15. 　Buffolo E， Branco JN， Gerola LR， et al. Off-pump myocardial revascularization：critical analysis of 23 years' experience in 3， 866 patients. Ann Thorac Surg， 2006， 81 （1）：85-89.
16. 　Gong QC， Xing JL， 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.
17. 　肖雅琼，杜心灵，孙宗全，等．主动脉内球囊反搏在冠状动脉旁路移植术围术期的应用．中国胸心血管外科临床杂志， 2007， 14 （3）：228-229．.
18. 　Pérez Vela JL， Martín Benítez JC， Carrasco González M， et al. Clinical practice guide for the management of low cardiac output syndrome in the postoperative period of heart surgery. Med Intensiva， 2012， 36 （4）：e1-e44.
19. 　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.
20. 　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.
21. 　Theologou T， Bashir M， Rengarajan A， et al. Preoperative intraaortic balloon pumps in patients undergoing coronary artery bypass grafting. Cochrane Database Syst Rev， 2011， 19 （1）：CD004472.
22. 　Moon C. Preoperative intra-aortic balloon pumping in high-risk cardiac surgery patients. Dimens Crit Care Nurs， 2012， 31 （4）：223-227.
23. 　Davidson J， Baumgariner F， Omari B， et al. Intra-aortic balloon pump:indications and complications. J Natl Med Assoc， 1998， 90 （3）：137-140.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of Intra-aortic Balloon Pump for High-risk Patients before Off-pump Coronary Artery Bypass Grafting

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