title: Reduced mortality in high-risk coronary patients operated off pump with preoperative intraaortic balloon counterpulsation.
abstract: BACKGROUND
  Preoperative intraaortic balloon pump (IABP) counterpulsation has better outcomes compared with perioperative or postoperative insertion in critical patients, and off-pump surgical procedures have been advocated to reduce mortality in high-risk patients. However, some surgeons are reluctant to perform beating heart operations in specific patient subgroups, including those with unstable angina or patients with low ejection fraction, because of their possible perioperative hemodynamic instability.
  
  
  METHODS
  We evaluated combined beating heart procedures and preoperative IABP in selected high-risk patients and compared our results with the predictive European System for Cardiac Operative Risk Evaluation (EuroSCORE) model. Fifty-five high-risk patients with a mean logistic EuroSCORE of 24 were prospectively enrolled and then divided into emergency (group 1, n = 25) and nonemergency (group 2, n = 30) groups. IABP was inserted immediately before operation in group 1 and the day before the procedure in group 2.
  
  
  RESULTS
  Compared with the EuroSCORE predictive model, a dramatic decrease in mortality occurred in both groups. Group I predicted mortality was 36.8%, and observed was 20%; and group 2 predicted mortality was 15.2% and observed was 0%. No specific complications from the use of IABP were encountered. During mid-term (2 years) follow-up, no patient died from a cardiac cause or required percutaneous coronary intervention or subsequent reoperation due to incomplete revascularization.
  
  
  CONCLUSIONS
  The combined use of preoperative intraaortic counterpulsation and beating heart intervention allows complete revascularization in high-risk patients with a important reduction in operative mortality and excellent mid-term results.
authors.affiliation: Department of Cardiac Surgery and Cardiology, Clinique Saint Luc, Brussels, Belgium. pierre.yves.etienne@skynet.be
authors.forename: Pierre Yves
authors.initials: PY
authors.lastname: Etienne
authors.forename: Spiridon
authors.initials: S
authors.lastname: Papadatos
authors.forename: David
authors.initials: D
authors.lastname: Glineur
authors.forename: Yves
authors.initials: Y
authors.lastname: Mairy
authors.forename: Elie
authors.initials: E
authors.lastname: El Khoury
authors.forename: Philippe
authors.initials: P
authors.lastname: Noirhomme
authors.forename: Gebrine
authors.initials: G
authors.lastname: El Khoury
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D015897:Comorbidity; D003327:Coronary Disease / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D007430:Intraoperative Care; D008297:Male; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate