Mortality and morbidity from intra-aortic balloon pumps. Risk analysis.
BACKGROUND
The purpose of this study, was to assess the incidence of and predictors for mortality and morbidity in patients who required postoperative intra-aortic balloon pump (IABP) support.


METHODS
We have retrospectively estimated 116 patients and data were statistically analyzed, and significant variables were evaluated with multivariate analysis.


RESULTS
Mortality rate was 57.8% (67 patients). Nineteen patients (16.3%) had major vascular complications: 12 patients (10.3%) limb ischemia, 1 patient (0.9%) aortic dissection, 6 patients (5.2%) mesenteric infarction. Thirty patients (25.8%) had minor vascular complication: 23 patients (19.8%) bleeding from insertion site, 7 (6%) patients infection of insertion site. Limb ischemia was resolved by IABP removal (10 patients), thrombectomy (2 patients). No patient required limb amputation. Sixty patients (51.7%) had renal insufficiency, of which 40 patients needed dialysis. Fifteen patients (10.3%) had neurological complications, 13 patients (11.2%) thrombocytopenia and 5 patients (4.3%) sepsis.


CONCLUSIONS
The incidence of IABP insertion in our institution was 1.5%. Mortality rate is similar to mortality of other studies in which the IABP has been inserted in the postoperative period. We have found that timing of IABP insertion, thrombocytopenia, presence of peripheral vascular disease and the redo intervention are independent predictors of mortality. We also found that female sex, diabetes, history of cigarette smoking and preoperative use of antiplatelet drugs are independent predictors of limb ischemia. The following factors are instead independent predictors of renal insufficiency: postoperative ejection fraction lower than 40% and non use of dobutamine in the postoperative period.
Meco
M
M
Division of Cardiac Surgery, Malan Center, S. Ambrogio Clinical Institute, Milan, Italy. mecoma@inwind.it
Gramegna
G
G
Yassini
A
A
Bellisario
A
A
Mazzaro
E
E
Babbini
M
M
Pediglieri
A
A
Panisi
P
P
Tarelli
G
G
Frigiola
A
A
Menicanti
L
L
Cirri
S
S
D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality*; D005260:Female; D006331:Heart Diseases / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014652:Vascular Diseases / Q000209:etiology* / Q000401:mortality*