Original article
Adult cardiac
Preoperative Intraaortic Balloon Pumping Improves Outcomes for High-Risk Patients in Routine Coronary Artery Bypass Graft Surgery

https://doi.org/10.1016/j.athoracsur.2008.11.007Get rights and content

Background

We evaluated the association between the preoperative use of intraaortic balloon pumping and in-hospital and long-term outcomes in high-risk patients undergoing coronary artery bypass grafting.

Methods

From 714 total patients undergoing coronary artery bypass grafting during a 4-year period, we compared the clinical, biochemical, and echocardiographic findings up to 1 year after surgery between 111 patients who had a European System for Cardiac Operative Risk Evaluation (EuroSCORE) of 12 or greater and received intraaortic balloon pumping preoperatively (group A) and 130 patients who had a EuroSCORE of 5 or less and received no preoperative intraaortic balloon pumping (group B).

Results

Group A patients were significantly older, had significantly more comorbid conditions, and had a significantly lower mean preoperative ejection fraction (all p < 0.001). Intraoperative data were comparable between groups, as were lactate and troponin I levels sampled from the coronary sinus. Lactate, troponin I, creatine kinase, and creatine kinase-MB mass showed comparable leakage at all postoperative times. The incidences of in-hospital mortality, perioperative myocardial damage, and acute myocardial infarction and duration of hospital stay were comparable. High-risk patients showed significant improvements in ejection fraction (p < 0.001) and wall-motion score index (p = 0.06) after surgery, but low-risk patients showed no significant change in these variables. The incidences of death, recurrent angina, myocardial infarction, and repeat coronary procedures did not differ significantly between groups.

Conclusions

The preoperative use of intraaortic balloon pumping appears to shift high-risk patients undergoing coronary artery bypass grafting into a lower-risk category and is associated with comparable perioperative troponin leakage and short-term and long-term outcomes similar to low-risk patients not receiving intraaortic balloon pumping.

Section snippets

Patients

Between January 2003 and May 2007, 714 patients underwent CABG at our academic institution. The present study compares the clinical and biochemical findings of 111 of these patients who underwent isolated CABG, who had a EuroSCORE of 12 or greater, and who received IABP support preoperatively (high-risk, group A) with those of 130 of these patients who underwent elective CABG, who had a EuroSCORE of 5 less, and who did not receive IABP support preoperatively (low-risk, group B). Patients

Results

The two groups showed significant differences in several demographic and clinical preoperative variables (Table 1), whereas intraoperative data and the release of lactate, troponin I, CK, and CK-MB mass from the coronary sinus were similar (Table 2). Accordingly, no differences were recorded in peripheral lactate, troponin I, CK, or CK-MB mass at all times. In particular, both high-risk and low-risk patients showed slight augmentation of postoperative enzymes, never reaching statistical

Comment

With the enormous growth of interventional cardiology in recent decades, patients coming to myocardial revascularization surgery are now more likely to have end-stage disease, with more-ischemic and energy-depleted hearts, compared with the era of coronary angioplasty and stenting [15]. Patients undergoing CABG are now older and sicker and have poorer ventricular function and more extensive disease [1, 2, 15]. Correspondingly, patients with failed angioplasty after myocardial infarction or

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