Pre-operative balloon counterpulsation and off-pump coronary surgery for high-risk patients.
Coronary artery bypass surgery (CABG) can be performed less invasively without cardiopulmonary bypass (CPB). Multivessel off-pump CABG (OPCAB) is challenging in patients with critical left main stenosis (> 70%) and/or severe ventricular dysfunction (ejection fraction < 0.35) Our objective was the evaluation of efficiency of intra aortic balloon pump (IABP) preoperatively in this high-risk group in order to perform OPCABG safely.


METHODS
In a consecutive 10-month period (out of 88 OPCABG patients) 23 high-risk patients were treated and were compared with 15 on-pump patients (out of 69) with the same criteria.


RESULTS
Preoperative implantation of IABP was significantly higher in the OPCABG group (70% vs 46%, p < 0.05). No conversion to CPB was required in the OPCABG group. Post-operative angiography was systematically performed and demonstrated 97.5% patency of anastomosis. No device-related complications occurred. No difference was found concerning age, risk factors, emergency surgery, ejection fraction, mean number of grafts per patient (2.64 versus 2.75) and average operating time. In contrast, OPCABG demonstrated a trend toward reduced morbidity in terms of atrial fibrillation, reexploration for bleeding and prolonged ventilator requirement > 12 h. Mortality was less in the OPCABG group (p < 0.05).


CONCLUSIONS
More randomized controlled trials are needed to evaluate the true efficacy of elective IABP in OPCABG high-risk patients. Until such studies are evaluated, and therefore because older and sicker patients now constitute a greater percentage of candidates for OPCABG, the timing of application of the IABP is warranted. These results may further justify preoperative use of the IABP in a large proportion of this group of patients.
Babatasi
G
G
Cardiovascular and Thoracic Surgery, University Hospital, Avenue Côte de Nacre, CHU Caen 14033 Caen, France. babatasi-g@chu-caen.fr
Massetti
M
M
Bruno
P G
PG
Hamon
M
M
Le Page
O
O
Morello
R
R
Khayat
A
A
D000368:Aged; D002315:Cardiopulmonary Bypass; D000075202:Contraindications; D001026:Coronary Artery Bypass / Q000379:methods*; D015908:Counterpulsation; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D014654:Vascular Patency