Perioperative heart failure in coronary surgery and timing of intra-aortic balloon pump insertion.
BACKGROUND
Perioperative heart failure (HF) in coronary operations is accompanied by a high operative mortality rate. An intra-aortic balloon pump (IABP) is often used to treat this syndrome. The correct timing for IABP insertion after completion of the operation has not yet been investigated. The aim of this study was to investigate the operative mortality in perioperative HF patients who had undergone coronary operations with respect to the early or the late use of IABP.


METHODS
This is a retrospective study including 7,270 patients who had undergone coronary surgery with or without associated procedures. A population of patients with perioperative HF was extracted and analyzed with respect to the use of drugs, intra-operative or post-operative IABP to treat this condition.


RESULTS
A total of 1,051 (14.5%) patients had perioperative HF. The mortality rate in this group was 13.5%. Early (intra-operative) IABP insertion was performed in 123 patients. In contrast, 928 patients were treated with inotropic drugs only, and, of these patients, 59 developed a drug-refractory HF requiring late IABP insertion. Operative mortality was significantly (P=0.001) higher in patients requiring late (64.4%) vs. early (41.5%) IABP insertion. Independent risk factors for developing a drug-refractory HF were age, pre-operative serum creatinine value and an associated mitral valve procedure.


CONCLUSIONS
Postponing the use of IABP may be deleterious in patients with drug-refractory HF. In the presence of the three factors independently associated with the risk of a drug-refractory HF, early IABP insertion is suggested.
Department of Cardiothoracic - Vascular Anesthesia and Intensive Care, IRCCS Policlinico S.Donato, Milan, Italy. cardioanestesia@virgilio.it
M
M
Ranucci
A
A
Ballotta
S
S
Castelvecchio
C
C
De Vincentiis
A
A
Biondi
A
A
Parisi
L
L
Menicanti
A
A
Frigiola
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000401:mortality; D001026:Coronary Artery Bypass; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D006334:Heart Function Tests; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007431:Intraoperative Complications / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate