title: Intraaortic balloon pumping in the treatment of low cardiac output following open heart surgery--immediate results and long-term prognosis.
abstract: From 1979 through 1986, 90 patients required intraaortic balloon pumping (IABP) due to low cardiac output complicating open heart surgery. Preoperatively, functional class III or IV was present in 92%; in patients with coronary artery disease (n = 54), three-vessel or left main disease was found in 72%; patients with valvular disease (n = 37) generally had multiple surgical procedures or valve re-replacement performed. Intra-IABP mortality was 49% (n = 44) and 30-day mortality 61% (n = 55). The latter figure decreased from 75% in 1979-81 to 53% in 1985-86. Cumulative 5-year survival was 22%. Logistic regression analysis identified as independent predictors of 30 day mortality the necessity for adjuvant treatment with the more powerful "pressure drugs" isoprenaline/noradrenaline, number of DC-defibrillations, functional classes III-IV, and chronic left ventricular failure. Different combinations of these risk factors identified different patient groups with 30-day mortalities ranging from 100% to 0%. The risk factors reflected both acute cardiac failure probably due to severe ischemia and chronic failure due to advanced primary disease. Taking the high-risk composition of the material into account, a 5-year survival of 22% cannot be regarded as discouraging. Continued employment of IABP treatment in open heart surgery, using an aggressive approach coupled with individualized inotropic support, seems justified.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Denmark.
authors.forename: O
authors.initials: O
authors.lastname: Lund
authors.forename: G
authors.initials: G
authors.lastname: Johansen
authors.forename: H
authors.initials: H
authors.lastname: Allermand
authors.forename: E
authors.initials: E
authors.lastname: Berg
authors.forename: T
authors.initials: T
authors.lastname: Petersen
authors.forename: L
authors.initials: L
authors.lastname: Hejl
mesh_terms: D000328:Adult; D000368:Aged; D002303:Cardiac Output, Low / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D002316:Cardiotonic Agents