Prophylactic Use Of Intra-aortic Balloon Pump Research Articles

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

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.

Intra-aortic balloon pump: indications, efficacy, guidelines and future directions.

The intra-aortic balloon pump (IABP) has been used as a cardiac assist device in various clinical situations since 1968 on the basis of the physiological principles and observational data, with little randomized data until recently. Recently published randomized controlled trials (RCTs) and meta-analyses have demonstrated acceptable safety for IABP but have raised doubt over efficacy in acute myocardial infarction (MI) both with and without cardiogenic shock. RCTs and meta-analyses have provided limited and qualified support for the efficacy of IABP in high-risk percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). There remains only observational data to support the efficacy of IABP in other niche indications, including mechanical complications of MI (acute severe mitral regurgitation and ventricular septal rupture) and refractory ventricular arrhythmia. Current randomized trial data and meta-analyses support the safety of IABP, but provide limited or no support for its efficacy in the treatment of high-risk MI, MI complicated by cardiogenic shock or the use of prophylactic IABP in high-risk PCI and CABG. Further studies to inform optimal patient selection, timing and use of associated therapies are required to characterize the role of IABP in contemporary practice and optimize outcome in high-risk patient subsets.

Prophylactic use of a preoperative intra-aortic balloon pump in patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting

Objective The aim of this work was to study the effectiveness of preoperative intra-aortic balloon pump (IABP) in patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting (CABG). Materials and methods We studied 80 consecutive patients of both sexes undergoing elective on-pump CABG having an ejection fraction less than 30%. Thirty patients received preoperative IABP support prophylactically, whereas 50 patients did not. The decision to put an IABP was made by the individual surgeon operating the patient. Preoperative, intraoperative, and postoperative variables were recorded and 30 days' follow-up was obtained. Results were subjected to statistical analysis. Results Fifty one patients (63.7%) were male while 29 (36.25%) were female with a mean age of 55.62 ΁ 9.65 years. Patients who received preoperative IABP had high in-hospital mortality (P = 0.002) and decreased rate of postoperative acute kidney injury (P = 0.048), ICU stay (P = 0.031) and less requirement for postoperative inotropic support (P = 0.047) compared to those who did not receive IABP preoperatively. ConclusionThe prophylactic use of IABP in patients with a low ejection fraction undergoing CABG does not decrease the mortality, but it has a favorable effect on postoperative major complications.

Prophylactic intra-aortic balloon pump in high-risk patients undergoing coronary artery bypass surgery

The aim of this study was to assess the efficacy of a prophylactic intra-aortic balloon pump (IABP) in high-risk patients undergoing coronary artery bypass graft surgery. MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar, and reference lists of relevant articles were searched. We included only randomized controlled trials. Assessments for eligibility, relevance, and study validity and data extraction were performed in duplicate using prespecified criteria. Meta-analysis was carried out using fixed-effect and random-effect models. Seven publications fulfilled our eligibility criteria. There was no important statistical heterogeneity or publication bias among included studies. In total, 177 patients received prophylactic IABP and 168 did not. Overall relative risk (RR) for hospital mortality in patients treated with prophylactic IABP was 0.255 [95% confidence interval (CI), 0.122-0.533; P<0.001; same results for both effect models]. Pooled RR for postoperative low cardiac output syndrome was 0.206 (95% CI, 0.109-0.389; P<0.001) for the fixed-effect model and 0.219 (95% CI, 0.095-0.504; P<0.001) for the random-effect model. Patients treated with prophylactic IABP presented an overall difference in means for length of intensive care unit stay and hospital stay, which was lower than that in the control group (P<0.001 for both effect models). Only 7.4% (13/177) of patients who received prophylactic IABP developed complications at an insertion site, with no IABP-related death. This meta-analysis supports the use of prophylactic IABP in high-risk patients to reduce hospital mortality.

Intra-aortic balloon pump in patients with ischaemic heart disease undergoing oesophagogastrectomy

Oesophagogastrectomy for carcinoma has a high operative mortality rate. Patients are elderly and ischaemic heart disease (IHD) is a recognised and frequent risk factor. To illustrate the use of the intra-aortic balloon pump (IABP) as prophylaxis against cardiac complications in a group of such patients. Five patients aged from 63 to 78 years were presented with operable adenocarcinoma of the oesophagus. They had IHD of a severity thought to pose a risk of myocardial infarction (MI) and/or failure at the time of oesophagogastrectomy. With the induction of anaesthesia, the IABP was inserted and left in situ for up to 24 hours. There were no major adverse perioperative cardiac events. Four patients were discharged from hospital on the eighth and one on the tenth postoperative day. The prophylactic use of IABP has a potential role in the prevention of cardiac complications in patients with IHD undergoing high risk non-cardiac surgery.

Stroke complicating percutaneous coronary interventions: incidence, predictors, and prognostic implications.

Stroke associated with percutaneous coronary intervention (PCI) is an infrequent although devastating complication. We investigated the incidence, predictors, and prognostic impact of periprocedural stroke in unselected patients undergoing PCI. A total of 9662 patients who underwent 12 407 PCIs between January 1990 and July 1999 were retrospectively studied. Stroke was diagnosed in 43 patients (0.38% of procedures). Patients with stroke were older (72+/-11 versus 64+/-11 years, P<0.001), had lower left ventricular ejection fraction (42+/-12 versus 46+/-13%, P=0.04) and more diabetes (39.5% versus 27.2%, P=0.07), and experienced a higher rate of intraprocedural complications necessitating emergency use of intra-aortic balloon pump (IABP) (23.3% versus 3.3%, P<0.001). In-hospital mortality (37.2% versus 1.1%, P<0.001) and 1-year mortality (56.1% versus 6.5%, P<0.001) were higher in patients with stroke. Compared with hemorrhagic stroke, patients with ischemic stroke had higher rate of in-hospital major adverse cardiac events (57.1% versus 25%, P=0.037). Multivariate logistic regression analysis identified emergency use of IABP as the strongest predictors for stroke (OR=9.6, CI 3.9 to 23.9, P<0.001), followed by prophylactic use of IABP (OR=5.1), age >80 years (OR=3.2, compared with age <50 years), and vein graft intervention (OR=2.7). Stroke associated with contemporary PCI is associated with substantial increased mortality. Elderly patients who experience intraprocedural complications necessitating the use of IABP are at particularly high risk.