The use of prophylactic intra-aortic balloon pump in high-risk patients undergoing coronary artery bypass grafting.

Ken Nakamura,Mitsuaki Sadahiro,Takao Shimanuki,Cholsu Kim,Tetsuro Uchida,Azumi Hamasaki,Kimihiro Kobayashi,Ri Sho,Hideaki Uchino,Andrea Ballotta

doi:10.1371/journal.pone.0224273

Ken Nakamura, Mitsuaki Sadahiro + Show 8 more

Open Access

https://doi.org/10.1371/journal.pone.0224273

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Journal: PloS one	Publication Date: Oct 28, 2019
Citations: 5	License type: CC BY 4.0

Affiliation: Yamagata University, Nihonkai General Hospital

Abstract

Intra-aortic balloon pump (IABP) is one of the most commonly used mechanical circulatory assist devices for high-risk patients undergoing cardiac surgery. In an effort to validate previously reported clinical outcomes, we describe the preoperative characteristics and outcomes of patients who underwent prophylactic IABP in high-risk patients undergoing coronary artery bypass grafting (CABG). A prospective observational study. From 2005 to 2017, 471 patients underwent either isolated or combined CABG at our institution. Of those, 393 patients underwent isolated CABG and were included for the analysis. Eighty-five patients (22%) were considered high-risk and underwent prophylactic IABP, with subsequent review of surgical morbidity and mortality rates. The 30-day postoperative mortality (prophylactic IABP group vs non prophylactic IABP group: 0% vs 1.6%, p = 0.589) and major adverse cardiac or cerebrovascular events (5.9% vs 3.3%, p = 0.333) were not significantly different between the two groups. Prolonged mechanical ventilation (>72 hours) (12.5% vs 4.2%, p = 0.014) occurred more frequently in the prophylactic IABP group. No IABP-related complications were noted, emphasizing that the use of prophylactic IABP in high-risk patients undergoing CABG is an acceptable option.

Highlights

Patients with ischemic heart disease, those requiring coronary artery bypass grafting (CABG), pose a major challenge for anesthesiologists and cardiothoracic surgeons, emphasizing the need for risk stratification and prophylactic measures to reduce postoperative morbidity and mortality
The 30-day postoperative mortality and major adverse cardiac or cerebrovascular events (5.9% vs 3.3%, p = 0.333) were not significantly different between the two groups
Dyub et al reported that patients who received prophylactic intra-aortic balloon pump (IABP) preoperatively had a mortality benefit with an odds ratio (OR) of 0.41 [6]

Summary

Introduction

Patients with ischemic heart disease, those requiring coronary artery bypass grafting (CABG), pose a major challenge for anesthesiologists and cardiothoracic surgeons, emphasizing the need for risk stratification and prophylactic measures to reduce postoperative morbidity and mortality. As a general community hospital, subspecialized providers–such as cardiac anesthesiologists–are unavailable, making preoperative and prophylactic interventions critical amongst patients undergoing intensive procedures. Intra-aortic balloon pump (IABP) is the most commonly used device for circulatory assistance in cardiac surgery and preoperative prophylactic IABP has been shown to improve outcomes in high-risk patients [1, 2]. In an effort to validate prior studies on the benefits of postoperative clinical outcomes, we conducted a prospective observational study of preoperative prophylactic IABP in high-risk patients undergoing CABG with the aim of describing subsequent morbidity and mortality rates

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Results

Conclusion