An 11-year, single-institution analysis of intra-aortic balloon pump use in cardiac surgery.
OBJECTIVE
The primary objective of this study was to analyze perioperative intra-aortic balloon pump (IABP) insertion in patients undergoing cardiac surgery in the authors' institution from 1995 to 2005 and to propose an explanation for changes in use over this period. A secondary objective was to assess patient variables associated with IABP use.


METHODS
This is a retrospective study including patients who underwent cardiac surgery between 1995 and 2005.


METHODS
The Cardiothoracic Anesthesia Patient Registry of a single teaching institution was queried to obtain the required information.


METHODS
Thirty thousand two hundred sixty-nine cardiac surgery patients.


METHODS
Intra-aortic balloon pump insertion before surgery, after cardiopulmonary bypass, or in the cardiovascular intensive care unit was assessed in patients who underwent isolated coronary artery bypass graft surgery, valve surgery, or both. Select patient variables were analyzed for their association with IABP insertion. Transesophageal echocardiography (TEE) examinations, milrinone use, and mortality rates also were determined.


RESULTS
Among 30,269 cardiac surgery patients, 1,310 (4.32%) underwent IABP insertion. Combined preoperative, intraoperative, and postoperative IABP use decreased from 7.8% in 1995 to 3.0% in 2005. Simultaneously, the intraoperative use of milrinone increased from 4.8% to 8.8% and postoperative use increased from 5.2% to 7.8%. The number of intraoperative TEE examinations more than doubled from approximately 1,700 to 3,500. The overall mortality for patients with preoperative, intraoperative, and postoperative IABP insertion was 12.6%, 17.5%, and 47.7%, respectively.


CONCLUSIONS
From 1995 to 2005, preoperative, intraoperative, and postoperative IABP use decreased by approximately 60% in cardiac surgery patients. Simultaneously, the use of TEE and milrinone each doubled. Although a cause-effect relationship cannot be established from the present study's observational data, the trends coincide and may be related.
Zaky
Sherif S
SS
Anesthesia Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
Hanna
Amgad H
AH
Sakr Esa
Wael A
WA
Xu
Meng
M
Lober
Cheryl
C
Sessler
Daniel I
DI
Gonzalez-Stawinski
Gonzalo
G
Savage
Robert M
RM
Bashour
C Allen
CA
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000401:mortality; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D017548:Echocardiography, Transesophageal; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects / Q000401:mortality; D007432:Intraoperative Period / Q000401:mortality; D016015:Logistic Models; D008297:Male; D020105:Milrinone / Q000627:therapeutic use; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors
D010726:Phosphodiesterase Inhibitors; D020105:Milrinone