Retrospective analysis of the clinical trends and current indications for perioperative intraaortic balloon pumping in high-risk coronary artery bypass surgery

Abstract

We clinically evaluated the current indications for perioperative intraaortic balloon pumping (IABP) in high-risk patients undergoing coronary artery bypass grafting (CABG). Over the past 22 years, 196 CABG patients received perioperative IABP at our institution. We divided the 22 years into periods I–IV (earliest to latest) and investigated the annual changes in the indications for and mortality from IABP. In periods I and II, IABP was mainly employed for postoperative low-output syndrome (LOS) or perioperative myocardial infarction (PMI). The hospital mortality rate was 13.2%–18.5%. In period III, the mortality rate was markedly reduced by the use of preoperative scheduled IABP. In period IV, however, scheduled IABP was used less often for high-risk CABG, and IABP was mainly employed in patients having emergency CABG for acute coronary syndrome (ACS). The hospital mortality rate was reduced to 3.7%. In the last 2 years, 19 (65.5%) of 29 patients who received preoperative IABP had emergency CABG for ACS, while 27 high-risk CABG patients with poor left ventricular (LV) function or left main trunk (LMT) disease were treated successfully without scheduled IABP. There were no significant differences between the IABP and non-IABP patients in age, sex, number of bypasses, and aortic cross-clamp time. Because of improvements in anesthesia, operative techniques, perioperative management, and cardioplegic solutions, preoperative support with IABP is less often needed for high-risk CABG, except in patients undergoing emergency surgery for ACS.