Early intra-aortic balloon pumping following perioperative myocardial injury improves hospital and mid-term prognosis.
We evaluated the impact of immediate intra-aortic balloon pumping (IABP) on hospital and mid-term outcome of coronary artery bypass graft (CABG) whenever perioperative acute complications developed. We compared clinical, biochemical, echocardiographic in-hospital results and two-year follow-up outcome of 30 low-risk (EuroSCORE<5) CABG (group A) who immediately received perioperative IABP when acute complications were suspected, to a contemporary, uncomplicated case-matched group (30 patients; Group B). Two in-hospital deaths were recorded in group A with no deaths in controls (P=0.492). Group A showed significantly higher lactate only at ICU arrival (P=0.001). Troponin I was always higher, but never reached values diagnostic for myocardial infarction (P<0.001). Worse left ventricular ejection fraction (P<0.001) and wall motion score index (P=0.008) were recorded at ICU arrival in group A, although an almost complete recovery was registered at discharge. Two-year actuarial survival was similar between the two groups (P=0.598). No differences were observed in freedom from acute myocardial infarction (P=0.503) and from overall cardiac complications (P=0.410). Early IABP should be established whenever cardiac complications are suspected, because of its beneficial impact on enzymatic leakage, myocardial recovery at echocardiography, hospital outcome, mid-term follow-up survival and freedom from cardiovascular events.
Rubino
Antonino S
AS
Cardiac Surgery Unit, University of Magna Graecia, Catanzaro, Italy. antonio.rubino@hotmail.com
Onorati
Francesco
F
Santarpino
Giuseppe
G
Abdalla
Karim
K
Caroleo
Santo
S
Santangelo
Ermenigildo
E
Renzulli
Attilio
A
D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D016022:Case-Control Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003422:Critical Care; D004452:Echocardiography; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects; D007770:L-Lactate Dehydrogenase / Q000097:blood; D007902:Length of Stay; D009200:Myocardial Contraction; D017682:Myocardial Stunning / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019990:Perioperative Care; D020127:Recovery of Function; D012189:Retrospective Studies; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood; D016277:Ventricular Function, Left
D015415:Biomarkers; D019210:Troponin I; D007770:L-Lactate Dehydrogenase