title: Should we discontinue intraaortic balloon during cardioplegic arrest? Splanchnic function results of a prospective randomized trial.
abstract: BACKGROUND
  Preoperative use of intraaortic balloon pumping (IABP) has increased in high-risk patients. Linear flow during cardiopulmonary bypass (CPB) can induce subclinical damage, whereas automatic IABP mode may maintain pulsatile flow. We sought to evaluate differences between suspending IABP and switching it to an automatic 80 bpm mode during cardioplegic arrest.
  
  
  METHODS
  Between January and November 2004, 40 patients undergoing preoperative IABP were randomized to receive either standard nonpulsatile CPB with IABP discontinued during cardioplegic arrest (20 patients; group A) or IABP-induced pulsatile (automatic 80 bpm) CPB (20 patients; group B). Hospital outcome was recorded. Urine output, blood urea nitrogen (BUN), creatine, creatinine clearance, peripheral lactate, recovery of gut motility, alanine-amino-transferase (ALT), aspartate-amino-transferase (AST), lactic dehydrogenase (LDH), bilirubin, and amylase (AMY) were compared.
  
  
  RESULTS
  There were no IABP-related complications, nor perioperative renal or liver failures, nor hospital deaths, nor myocardial infarctions. Intensive care and hospital stay, urine output, and recovery of gut motility were comparable. Group B showed lower creatine on the first (p = 0.01) and second (p = 0.005) postoperative days, higher creatinine clearance (first day: p = 0.01; second day: p = 0.03), lower lactate after CPB termination (p = 0.0001) and during the first day (p = 0.001). The ALT, AST, and AMY were lower in group B (first day ALT: p = 0.01; AST: p = 0.04; AMY: p = 0.017; second day ALT: p = 0.01; AST: p = 0.02; AMY: p = 0.027), as well as total bilirubin (first day: p = 0.05; second day: p = 0.02).
  
  
  CONCLUSIONS
  Automatic 80 bpm IABP during cardioplegic arrest improves creatinine clearance and splanchnic enzymes. There is no reason to suspend preoperative IABP support during cardioplegic arrest.
authors.affiliation: Cardiac Surgery Unit, Magna Graecia University, Catanzaro, Italy. frankono@libero.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
authors.forename: Lucia
authors.initials: L
authors.lastname: Cristodoro
authors.forename: Pasquale
authors.initials: P
authors.lastname: Mastroroberto
authors.forename: Antonio
authors.initials: A
authors.lastname: di Virgilio
authors.forename: Antonio
authors.initials: A
authors.lastname: Esposito
authors.forename: Massimo
authors.initials: M
authors.lastname: Bilotta
authors.forename: Attilio
authors.initials: A
authors.lastname: Renzulli
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D011446:Prospective Studies; D013152:Splanchnic Circulation