Preoperative intraaortic balloon pumps in high-risk patients undergoing open heart surgery.
BACKGROUND
The use of the preoperative intraaortic balloon pump (IABP) in patients with severe left ventricular dysfunction or unstable angina with critical coronary anatomy is becoming more frequent as surgical casemix changes. The aim of this study was to determine the impact of preoperative IABP use on survival in high-risk patients having open heart surgery.


METHODS
Prospectively collected data for 645 consecutive patients were reviewed. Patients receiving an IABP were identified and grouped as follows: group A (preoperative IABP for high-risk nonemergent cases), group B (preoperative IABP for emergent cases), and group C (intra/postoperative IABP). Risk-adjusted hospital mortality rates in these three groups was compared using the modified Parsonnet score for preoperative risk stratification.


RESULTS
IABPs were used in 101 cases (16%). The predicted versus actual hospital mortality rate was 20% versus 5.7% in group A, 32.1% versus 47.6% in group B, and 12.6% versus 22.2% in group C (group A vs group B, p = 0.0014; group A vs group C, p = 0.012). IABP-related morbidity occurred in 3% of cases (all in group C).


CONCLUSIONS
Risk-adjusted mortality was significantly lower in high-risk cases with preoperative IABPs compared with emergent cases and intraoperative/postoperative IABPs. We encourage the use of preoperative IABPs in selected high-risk patients.
Kang
N
N
Department of Cardiothoracic Surgery, Royal Perth Hospital, Australia. nicholak@bigpond.com
Edwards
M
M
Larbalestier
R
R
D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D002423:Cause of Death; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics / Q000502:physiology; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011300:Preoperative Care; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*