Frequency of intra-aortic balloon pump insertion and associated factors in coronary artery bypass Grafting in a tertiary care hospital.

Imtiaz Ahmad,Mujahid Ul Islam,Bahauddin Khan,Mujeeb Ur Rehman

doi:10.12669/pjms.37.2.3614

Abstract

Objective:To find the incidence of intra-aortic balloon pump (IABP) induction and factors associated with its insertion in coronary artery bypass grafting (CABG).Methods:This retrospective observational non interventional study was conducted at Cardiac Surgery Department, North West General Hospital and Research Center, Peshawar from December 2018 to March 2020. The total sample size was 360 patients who underwent coronary artery bypass grafting (CABG). The research was piloted in the cardiac operation theatre then cardiac intensive care unit (CICU) of Northwest General Hospital and Research center Hayatabad Peshawar. Data was collected from 360 patients scheduled for CABG. Total numbers of patients in whom IABP was inserted and factors associated with IABP insertions were noted. All the information was collected on a specifically prepared Form. Data was entered and evaluated in statistical package for social sciences form 25.Results:In this study, a total of 360 patients were observed who underwent coronary artery bypass grafting (CABG). We determined the frequency of IABP induction and the factors related to it. Gender distribution among patients who were assisted with IABP was 43% female and 57% male. IABP induction was done for most of moderately to severely reduced ejection fraction patients. Other factors related to patients who required IABP support were previous myocardial infarction 100%, hypertension 86%, diabetes mellitus 64%, coronary end-arterectomy 21% and smoking 7%. The results were analyzed. We have used the (SPSS) version 25 and Chi-square test for analysis in which the P-value less than 0.00001 is statistically significant.Conclusion:Incidence of insertion of IABP among CABG population was 3.9% in our hospital. It is an essential support to post CABG patient with left ventricular dysfunction after cardiopulmonary bypass with moderate to severely reduced ejection fraction, Myocardial infarction, hypertension, diabetes mellitus. Smoking and endarterectomy were not significantly related to IABP induction in our study. Multicenter study is still required to find out the other factors governing the IABP insertion.

Highlights

Coronary artery disease (CAD) has been considered the important cause of death worldwide
The highest incidence of intra-aortic balloon pump (IABP) insertion was significant in patients with moderately reduced left ventricular Ejection Fraction (EF) as the P-value is 0.00000 and we have found the same frequency in the severely reduced EF
Surgical intervention is successful in patients with severe coronary artery disease yet, increasing benefits coupled with elevated threat, for older patients with comorbidities like hypertension, diabetes mellitus, chronic obstructive pulmonary disease etc. remain a cause for concern

Summary

Introduction

Coronary artery disease (CAD) has been considered the important cause of death worldwide. Prognosis of CAD is dependent on interventions, baseline personality and genetics.[2] With the progress of coronary interventional treatment and the popularity of PCI, patients who are experiencing CABG are aged and might have more common coexisting diseases like diabetes mellitus and chronic renal failure which lead to high risk of cardiac surgery.[3]. For cardiac surgery risk evaluation Euro SCORE has been extensively used, which stratifies cardiac surgical risk into three categories: low-risk (0–2 points); intermediate-risk (3–5 points), and high-risk (more than or equal six points.[4] These high risk patients with coronary artery disease presenting for CABG mostly have left ventricular (LV) dysfunction.[5] Most of the research has revealed an encouraging survival advantage in patients undergoing surgical treatment of CAD.[6,7] severe LV dysfunction (ejection fraction ≤ 35%) is stated to be the predictor of low cardiac output syndrome and mortality in CABG.[7,8]

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