Preoperative intra-aortic balloon pump to reduce mortality in coronary artery bypass graft: a meta-analysis of randomized controlled trials.

Alberto Zangrillo,Gabriele Finco,Marta Eugenia Sassone,Teresa Greco,Ambra Licia Di Prima,Roberto Dossi,Fabrizio Monaco,Giovanni Landoni,Mario Musu,Federico Pappalardo

doi:10.1186/s13054-014-0728-1

Abstract

IntroductionThe intra-aortic balloon pump is routinely used in cardiac surgery; however, its impact on outcome is still a matter of debate and several randomized trials have been published recently. We perform an updated meta-analysis of randomized controlled trials that investigated the use of preoperative intra-aortic balloon pump in adult patients undergoing coronary artery bypass grafting.MethodsPotentially eligible trials were identified by searching the Medline, Embase, Scopus, ISI Web of Knowledge and The Cochrane Library. Searches were not restricted by language or publication status and were updated in August 2014. Randomized controlled trials on preoperative intra-aortic balloon pump in patients undergoing coronary artery bypass grafting either with or without cardiopulmonary bypass were identified. The primary end point was mortality at the longest follow-up available and the secondary end point was 30-day mortality.ResultsThe eight included randomized clinical trials enrolled 625 patients (312 to the intra-aortic balloon pump group and 313 to control). The use of intra-aortic balloon pump was associated with a significant reduction in the risk of mortality (11 of 312 (3.5%) versus 33 of 313 (11%), risk ratio = 0.38 (0.20 to 0.73), P for effect = 0.004, P for heterogeneity = 0.7, I-square = 0%, with eight studies included). The benefit on mortality reduction was confirmed restricting the analysis to trials with low risk of bias, to those reporting 30-day follow-up and to patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass.ConclusionsPreoperative intra-aortic balloon pump reduces perioperative and 30-day mortality in high-risk patients undergoing elective coronary artery bypass grafting.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0728-1) contains supplementary material, which is available to authorized users.

Highlights

The intra-aortic balloon pump is routinely used in cardiac surgery; its impact on outcome is still a matter of debate and several randomized trials have been published recently
The intra-aortic balloon pump is used in different clinical conditions where myocardial function is diminished, even if its effect on outcome is debated; it does not improve 30-day and one-year survival in patients with acute coronary syndrome complicated by cardiogenic shock undergoing revascularization [1,2]
The overall result was confirmed restricting the analysis to trials that reported the 30-day mortality (Figure 5) (11 of 254 (4.3%) in the intra-aortic balloon pump group versus 25 of 260 (9.6%) in the control group, risk ratio = 0.42 (0.21 to 0.86), P for effect = 0.02, P for heterogeneity = 0.6, I-square = 0%, with six studies included) and in surgeries performed with cardiopulmonary bypass (9 of 190 (4.7%) in the intra-aortic balloon pump group versus 27 of 173 (16%) in the control group, risk ratio = 0.36 (0.17 to 0.74), P for effect = 0.01, P for heterogeneity = 0.5, I-square = 0%, with six studies included) (Additional file 2: Figure S1)

Summary

Introduction

The intra-aortic balloon pump is routinely used in cardiac surgery; its impact on outcome is still a matter of debate and several randomized trials have been published recently. We perform an updated meta-analysis of randomized controlled trials that investigated the use of preoperative intra-aortic balloon pump in adult patients undergoing coronary artery bypass grafting. A recent randomized trial on intra-aortic balloon pump use in coronary artery bypass graft surgery was underpowered to confirm the beneficial effects of intra-. We decided to perform an updated metaanalysis of randomized trials studying the effect of preoperative intra-aortic balloon pump use in coronary artery bypass graft surgery to address the effect of this therapy on survival Zangrillo et al Critical Care (2015) 19:10 aortic balloon pump on survival and concluded that in patients undergoing nonemergent coronary operations, with a stable hemodynamic profile and a left ventricular ejection fraction less than 35%, the preincision (after anesthesia induction and before skin incision) insertion of intra-aortic balloon pump did not result in a better outcome [10].

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Conclusion