title: Trends in intraaortic balloon counterpulsation complications and outcomes in cardiac surgery.
abstract: 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.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital, Geneva, Switzerland. jtchristenson@hotmail.com
authors.forename: Jan T
authors.initials: JT
authors.lastname: Christenson
authors.forename: Marc
authors.initials: M
authors.lastname: Cohen
authors.forename: James J
authors.initials: JJ
authors.lastname: Ferguson
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Freedman
authors.forename: Michael F
authors.initials: MF
authors.lastname: Miller
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
authors.forename: Ramachandra C
authors.initials: RC
authors.lastname: Reddy
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Philip M
authors.initials: PM
authors.lastname: Urban
mesh_terms: 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