Impact on intra-aortic balloon pump placement technique on cardiac surgical patient outcomes

Abstract

Introduction Although the use of intra-aortic counterpulsation in cardiogenic shock was recently debated¹, it remains widely used device for the treatment of cardiac failure. The aim of our study was to evaluate intra-aortic balloon pump (IABP) placement technique related morbidity in cardiac surgical patient population. Methods Single center retrospective review of 424 cardiac surgical patients treated with intra-aortic counter-pulsation between January 1, 2013 and April 30, 2019 in a tertiary care center. Patient outcomes, procedure related morbidity and IABP insertion technical characteristics were evaluated (elective vs urgent, sheathed vs sheathless, ideal balloon tip position vs malposition). According to tip position patients were divided into three groups: good (at T2-T4 vertebrae), malposition (T5-T6), severe malposition (at T7 or below). Results Median patient age was 67 [Interquartile range (IQR), 59 to 75 years], 307 (72.4%) were male. Median EuroSCORE II was 4.4 [IQR, 2.4 to 10.5], median LVEF was 35 [IQR, 28 to 50]. Indications for IABP treatment were: cardiac failure or angina treatment before surgery in 45 (10.6%) patients, prophylactic use in high risk 178 (42.0%) patients, hemodynamically unstable before CPB in 5 (1.2%), hemodynamically unstable during off-pump CABG in 11 (2.6%), facilitate weaning from CPB in 47 patients (11.1%) low cardiac output following surgery in 137 (32.3%), weaning from ECMO in 1 (0.2%). Three hundred forty nine patients (82.3 %) survived to hospital discharge. In-hospital mortality was 5.1% in elective IABP placement group vs 26.8% in urgent IABP implementation group (p Discussion Elective balloon placement was associated with lower morbidity in cardiac surgical patients. Sheathed insertion showed a tendency of higher rate of vascular complications. Suboptimal IABP tip position was not associated with adverse outcome.