Abstract
Objective:The aim of our study is to analyze the characteristics, morbidity and mortality of patients requiring an Intra-Aortic Balloon Pump (IABP) in Coronary Artery Bypass Grafting (CABG).Methods:An analysis was done on the prospectively collected data of 1216 patients who had CABG in our center between July, 2017 and May, 2019 at our hospital. We categorized patients in to an IABP and non-IABP group on the basis of IABP use. We then compared the pre-operative, per-operative and post-operative characteristics of the two groups. We further stratified the patients according to pre-op ejection fraction (EF).Results:Out of 1216 patients, 135(11.10%) patients required an IABP. 70(51.9%) patients of IABP group and 699(64.7%) patients of non-IABP group had hypertension (p-value 0.0036). 23.0% had previous myocardial infarction (MI) in the IABP group and 13.8% had prior myocardial infarction (MI) in non-IABP group (p-value 0.0463). Among the patients requiring an IABP, 21(15.5%) of patients had normal EF (>50%) (P-value<0.0001), 72 (53.3%) had EF 35-50%, and 41(30.3%) patients had EF<35% (p-value <0.0001). Mortality of IABP group (19.3%) was greater than non-IABP group (2.4%) (P-value 0.00001).Conclusions:Use of IABP increased as the EF decreased. Rate of post-operative stroke, prolonged ICU stay, prolonged ventilation, re-opening due to bleeding and mortality was seen to be significantly higher in the IABP group.
Highlights
One of the most dreadful complication encountered following Coronary Artery Bypass Grafting (CABG) is low cardiac output syndrome (LCOS)
LCOS following CABG is known to increase the risk of mortality, stroke, myocardial infarction, pulmonary complications, renal failure, as well as need for reopening.[1]
Intra-Aortic Balloon Pump (IABP) is a mechanical device in which the balloon inflates just after the closure of the aortic valve causing an increase in diastolic pressures and deflates just before the opening of the aortic valve thereby decreasing the afterload and improving systolic pressures
Summary
One of the most dreadful complication encountered following CABG is low cardiac output syndrome (LCOS). LCOS following CABG is known to increase the risk of mortality, stroke, myocardial infarction, pulmonary complications, renal failure, as well as need for reopening.[1]. If the trend of deterioration cannot be reversed by means of inotropic support, mechanical assist devices (MADs) are used. Amongst MADs, the most frequently used device is the IABP counter pulsation. IABP has been known to reduce mortality.[3] IABP is a mechanical device in which the balloon inflates just after the closure of the aortic valve causing an increase in diastolic pressures and deflates just before the opening of the aortic valve thereby decreasing the afterload and improving systolic pressures. The most common complications associated with IABP are local hematoma formation, local and systemic infection, limb ischemia, balloon rupture/damage, passage failure, aortic perforation/dissection.[6]
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