Trends in intraaortic balloon counterpulsation complications and outcomes in cardiac surgery.
BACKGROUND
As the proportion of high-risk patients for cardiac surgery increases, use of intraaortic balloon counterpulsation (IABC) has increased, especially in preoperative therapy. Although the efficacy and cost-effectiveness of IABC have been demonstrated, historically higher complication rates have dissuaded some practitioners from using IABC.


METHODS
This report describes IABC use in cardiac surgery, examines trends in complications over time, and compares outcomes in preoperative versus postoperative use in a single prospective worldwide registry over the past 3 years.


RESULTS
The frequency of IABC use appears to be increasing with time as the complication rates have dramatically fallen. The overall IABC-related complication rate was 6.5% (460/7,101), and the rate of major complications (requiring surgery or transfusion) was 2.1% (148/7,101). Hospital mortality was significantly lower in patients treated preoperatively with IABC compared with patients treated postoperatively (8.8% vs 28.2%, p < 0.0001), although this may be due to a selection bias in the postoperative group.


CONCLUSIONS
Preoperative IABC therapy leads to better patient outcomes in high-risk CABG patients. Improved IABC technology and better surveillance have led to increased use with lower complication rates. Although selection bias is inherent in retrospective studies, the Benchmark Counterpulsation Outcomes Registry outcomes are in close concordance to prospective randomized studies previously reported.
Christenson
Jan T
JT
Department of Cardiovascular Surgery, University Hospital, Geneva, Switzerland. jtchristenson@hotmail.com
Cohen
Marc
M
Ferguson
James J
JJ
Freedman
Robert J
RJ
Miller
Michael F
MF
Ohman
E Magnus
EM
Reddy
Ramachandra C
RC
Stone
Gregg W
GW
Urban
Philip M
PM
D006348:Cardiac Surgical Procedures; D016208:Databases, Factual; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects* / Q000401:mortality; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome