Abstract
Objective: Hemodynamic deterioration during positioning of the heart has been the most critical complication of off-pump coronary artery bypass surgery. Pre-operative use of intra-aortic balloon pump has been shown to prevent this complication in high risk patients. The role of balloon pump in high risk patients has been questioned by our group. We modified the role of balloon pump in our patients, thus avoiding the conversion to cardiopulmonary bypass. Methods: 4063 off-pump coronary bypass surgeries were performed by a single surgeon in our center, over thirteen years. 130 intra-aortic balloons used between July 2002 and December 2015 were removed from the the-ater, once the distal anastomosis was performed. We studied this group of patients for—time and need for insertion, duration of balloon used, local insertion problems and survival. Results: Initially, we inserted intra-aortic balloons in high risk patients. We observed that, patients with low ejection fraction and patients with critical left main coronary artery disease were not the ones who actually needed balloon pump support. It was the patients who had ongoing ischemia, with preserved left ventricular function, and ST depression intra-operatively, who needed balloon pump support to perform complete anatomical revascularization. Conclusions: Intra-aortic balloon pump has helped us to position the heart without hemodynamic instability, thereby avoiding conversion to cardio-pulmonary bypass. This enabled us to perform off-pump surgery in virtually all areas of the heart, thus maintaining perfect hemodynamics.
Highlights
The increase in Off-Pump Coronary Artery Bypass (OPCAB) numbers has been aided by technical advances and increased surgical experience but had been limited by the lack of an effective technique for successful grafting of the posterior coronary branches of the left circumflex artery
We have audited all the patients who had the Intra-Aortic Balloon Pump (IABP) used between July 2002-Dec 2015
We used IABP in all these patients before starting any inotropes, and that prevented our conversion to CPB
Summary
The increase in OPCAB numbers has been aided by technical advances and increased surgical experience but had been limited by the lack of an effective technique for successful grafting of the posterior coronary branches of the left circumflex artery. Use of IABP has been shown to avoid complications in high risk patients, when used preoperatively [1]. The use of IABP, either preoperative or intraoperative to reduce operative risk and to facilitate posterior vessel grafting, has been well documented [7]. Preoperative IABP counter pulsation has been shown to have better outcomes compared with perioperative or postoperative insertion in critical patients [7]. Off-pump surgical procedures have been advocated to reduce mortality in such high-risk patients. In patients with high risk factors, higher mortality and morbidity rates have been demonstrated in spite of massive pharmacologic support combined with postoperative IABP support [7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
