Preoperative intra-aortic balloon pump improves the clinical outcomes of off-pump coronary artery bypass grafting in left ventricular dysfunction patients.

Feng Yang,Xiaofang Yang,Yu Jiang,Xiaotong Hou,Chengxiong Gu,Lizhong Sun,Jinhong Wang,Ran Dong,Jialin Xing,Dengbang Hou,Hong Wang,Xing Hao,Zhi Chen Xing,Na Miao,Feng Liu,Chunjing Jiang,Zhongtao Du,Yanyan Zhao

doi:10.1038/srep27645

Abstract

Severe left ventricular (LV) dysfunction patients undergoing off-pump coronary artery bypass grafting (OPCAB) are often associated with a higher mortality. The efficacy and safety of the preoperative prophylactic intra-aortic balloon pump (IABP) insertion is not well established. 416 consecutive patients with severe LV dysfunction (ejection fraction ≤35%) undergoing isolated OPCAB were enrolled in a retrospective observational study. 191 patients was enrolled in the IABP group; the remaining 225 patients was in control group. A total of 129 pairs of patients were propensity-score matched. No significant differences in demographic and preoperative risk factors were found between the two groups. The postoperative 30-day mortality occurred more frequently in the control group compared with the IABP group (8.5% vs. 1.6%, p = 0.02). There was a significant reduction of low cardiac output syndrome in the IABP group compared with the control group (14% vs. 6.2%, p = 0.04). Prolonged mechanical ventilation (≥48 h) occurred more frequently in the control group (34.9% vs. 20.9%, p = 0.02). IABP also decreased the postoperative length of stay. Preoperative IABP was associated with a lower 30-day mortality, suggesting that it is effective in patients with severe LV dysfunction undergoing OPCAB.

Highlights

Severe left ventricular (LV) dysfunction patients undergoing off-pump coronary artery bypass grafting (OPCAB) are often associated with a higher mortality
A total of 416 patients were included in this study (Fig. 1), with 191 patients in the Intra-aortic balloon pump (IABP) group and 225 patients in the control group
Lower limb ischemia requiring surgical intervention was observed in 1 patient (0.8%) in the IABP group (Table 2). This large regional study of propensity-matched patients indicated that preoperative prophylactic IABP insertion was associated with reduced postoperative 30-day mortality in severe LV dysfunction patients who underwent Off-pump coronary artery bypass graft (OPCAB)

Summary

Introduction

Severe left ventricular (LV) dysfunction patients undergoing off-pump coronary artery bypass grafting (OPCAB) are often associated with a higher mortality. Patients with severe LV dysfunction have generally been excluded from OPCAB procedures by some cardiac surgeons because of the potential risk for hemodynamic deterioration and conversion to on-pump coronary artery bypass graft (CABG)[9]. Previous reports have shown conflicting results for preoperative IABP insertion in high-risk patients undergoing surgical revascularization[12,13,14,15,16,17,18,19,20], the evidence from several meta-analyses support preoperative IABP insertion for high-risk patients[12,14,17] These meta-analysis studies included few OPCAB patients. Dysfunction that underwent OPCAB and performed a propensity-matched analysis to determine whether these patients benefited from preoperative prophylactic IABP insertion

Methods

Results

Conclusion