The effects of intra-aortic balloon counterpulsation for valve replacement in patients with severe valvular heart disease

Abstract

Objective To evaluate the effects of intra-aortic balloon pump (IABP) for valve replacement in patients with severe valvular heart disease.Methods The 60 patients with severe valvular heart disease who need surgical treatment were randomly divided into treated groups (n=30) and control group (n=30) with random digits table.The patients in treated group were inplanted with IABP preoperatively and cardiac resuscitated after operation.The patients in control group were not inplanted with IABP.The hemodynamic parameters in different time [time before anesthesia (T0),5 min after induction of anesthesia (T1),before cardio pulmonary bypass(T2),60 min after cardio pulmonary bypass(T3),the termination of cardio pulmonary bypass(T4),6 h after surgery(T5),12 h after surgery(T6),24 h after surgery(T7) 48 h after surgery(T8)] were recorded.During of T2-T8,urine volume was recorded and venous blood was extracted for quantifying the serum creatine kinase (CK),the creatine kinase-MB (CK-MB),cardiac troponin I (cTnI),lactic acid (Lac).Other parameters were also recorded.Results Parameters of mean artery pressure(MAP),heart rate (HR),central venous pressure (CVP),left atrial pressure (LAP) urine output,operation time,emergency cardiac care (ECC),cardiac resuscitation rate difference in treated group and control group were not significant different (P＞0.05) at each time point.Theplasma concentration of CKin at T5-Ts [(623±45),(432±34),(339±40),(252±21) U/L] and CK-MB [(172±37),(146±29),(122±29),(78±21) U/L] and cTnI [(48.84±7.73),(41.33±8.30),(30.80±6.42),(20.23±6.02) μg/L] and Lac [(3.1±0.8),(2.1:±0.9),(1.5±0.7),(1.2±0.5) mmol/L] in treated group were significantly lower than control group (P＜0.05).The consumption of dopamine[(7.2±2.1)μg·kg-1·min-1] and dobutamine [(7.2±2.1)μg·kg-1·min-1] after surgery were significantly reduced (P＜0.05),and the cases applied of adrenaline(0/30) were also significant reduced (P＜0.01) in treated group.The time of ventilation time [(18.3±7.6) h],time of ICU stayed [(4.8±1.2) d],hospitalization time after surgery (13.8±4.8) d and mortality (0/30) in treated group were lower than that in control group (P＜0.05).Conclusions Preoperative inplantation of IABP in patients with severe valvular heart disease during surgery of valve replacement could protect the myocardium,increased the survival of patients. Key words: Severe; Valvular heart disease; Intra-aortic balloon counterpulsation