Abstract P155: Perioperative Intra-Aortic Balloon Pump Counterpulsation and Outcomes in Very Elderly

Abstract

Introduction: Indications for use of intra aortic balloon pump (IABP)are low ejection fraction, shock, left main stem disease, unstable angina, refractory angina and redo operation. These were supported by trials which included few very elderly patients (older than 80). Octogenarians are increasingly undergoing Coronary artery bypass surgery often needing IABP use. Hypothesis: we plan to test the utility and effectiveness of IABP in improving outcomes in very elderly patients undergoing isolated coronary artery bypass grafting (CABG). Methods: We performed a retrospective analysis of very elderly patients who underwent coronary artery bypass from 01/2001 to 12/2008. Statistical analysis is performed by STATA. Results: A total of 450 patients older than 80 underwent CABG during eight years. The mean age of the total subjects was 83.16+/- 2.48. A total of 35 (7.78%) patients underwent perioperative IABP of whom 14 (40%) died. Mortality among Non-IABP group was 7.47% (31/415).This was statistically significant at p<0.000.Higher mortality in IABP group was seen across all the subset of patients with accepted guideline based indication including shock, low EF, Left main stem disease, Unstable angina. Higher mortality was also seen in other risk factors like CHF, renal failure. Patients who underwent IABP placement experienced other adverse outcomes like longer mean extubation time of 151.6 hrs (CI 24-301 ) compared to 27.03 hrs ( CI 19 - 34.07) in Non-IABP group. Need for more than two inotropes was 44% (11/25) in IABP whereas it was 4.84 % (17/351) in Non-IABP group. No clear relation to postoperative atial fibrillation was found. Post operative renal failure was 9.38 (3/32) in IABP group compared to 2.24(9/401) in Non IABP group with a p <.01.We didn't had enough power to look into post-operative Cerebrovascular accident. In multivariate regression analysis after adjustment for confounding variable placement IABP has higher mortality with an OR 2.31 (1.14-3.48) p<.0001 Conclusions: In very elderly patients mortality rate is very high even for indications supported by ACC/AHA guidelines. We need prospective studies focusing on very elderly patients.