The use of preoperative intra-aortic balloon pump in open heart surgery.
OBJECTIVE
Intra-aortic balloon pump (IABP) therapy before open heart surgery has been suggested for ''high risk'' patients.


METHODS
Records from patients undergoing open heart surgery at our institution between June 1999 and February 2002 were reviewed. Indication for IABP insertion was severely impaired left ventricular function, acute myocardial infarction (MI) or unstable angina.


RESULTS
Fifty-five patients were included in the study: 41 male, 14 female, age 64+/-9 years. Fifty-one (92.7%) required coronary artery bypass brafting (CABG) alone or as a combined procedure, 2 (3.6%) required mitral valve surgery, and 2 (3.6%) needed more complex cardiac procedures. Thirty-two patients (58%) underwent emergency cardiac surgery and 11 patients (20%) suffered from acute preoperative MI. The overall 30 days mortality was 9%. Mean intensive care unit (ICU) stay was 6+/-8 days. Four patients (7.2%) developed postoperative renal failure requiring temporary hemodialysis. Three patients (5.4%) developed IABP related peripheral vascular complications.


CONCLUSIONS
Perioperative morbidity and mortality is increased despite preoperative IABP, particularly in patients with acute MI. In contrast to studies not using this approach, preoperative IABP reduces morbidity and mortality of high risk patients. IABP related complications are low. Our data suggest that high risk patients profit from preoperative IABP therapy, however, prospective studies are needed to confirm these findings.
Pfeiffer
S
S
Erlangen-Nürnberg Center for Cardiac Surgery Friedrich Alexander, University of Erlangen, Erlangen, Germany. s.pfeiffer@klinikum-nuernberg.de
Frisch
P
P
Weyand
M
M
Ensminger
S M
SM
Tandler
R
R
Sirch
J
J
Fischlein
T
T
Cesnjevar
R
R
D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007423:Intra-Aortic Balloon Pumping; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011300:Preoperative Care; D012189:Retrospective Studies; D012306:Risk; D015996:Survival Rate