title: IABP before cardiac surgery: clinical benefit compared to intraoperative implantation.
abstract: BACKGROUND
  The aim of this study was to determine whether preoperative compared to intraoperative intra-aortic balloon counterpulsation (IABP) is advantageous regarding 30-day and 2-year survival in high-risk patients (acute myocardial infarction, severely impaired left ventricular ejection fraction (LVEF), low output syndrome) undergoing coronary surgery.
  
  
  METHODS
  In the years 2004 to 2008, 156 consecutive patients undergoing coronary surgery with IABP support (119 preoperative, 37 intraoperative IABP) were observed. Applying Fisher's exact test, as well as Wilcoxon and median tests, possible group differences were evaluated. After univariate analysis, models of logistic regression and Cox-regression were built.
  
  
  RESULTS
  Preoperative hemodynamic state and risk profile of the two patient groups were comparable: patients with preoperative IABP showed a similar level of urgency (21.9% vs. 18.9% emergencies), cardiogenic shock (8.4% vs. 10.8%), inotropes (8.4% vs. 8.1%), impaired LVEF (30.3% vs. 29.7%) and ventilation (5.9% vs. 5.4%) compared to patients with intraoperative IABP. Nevertheless, patients with intraoperative IABP demonstrated a significantly higher 30-day mortality rate (37.8% vs. 5.9%) and 2-year mortality rate (54.0% vs. 18.1%) compared to patients with preoperative IABP. Logistic regression revealed that patients with intraoperative IABP have a 16-times higher 30-day mortality rate after coronary surgery (OR: 16.386, 95% CI: 4.858-55.266) than patients with preoperative IABP. Two-year mortality (OR: 9.317, 95% CI: 3.430 to 25.311) and survival time were significantly better in patients with preoperative IABP therapy.
  
  
  CONCLUSIONS
  Considering the significant benefit for patients with preoperative compared to intraoperative IABP and the absence of vascular problems after IABP insertion, the results of this study indicate a more liberal indication for IABP in high-risk patients before coronary bypass surgery.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany. andreas.boening@chiru.med.uni-giessen.de
authors.forename: A
authors.initials: A
authors.lastname: Böning
authors.forename: S
authors.initials: S
authors.lastname: Buschbeck
authors.forename: P
authors.initials: P
authors.lastname: Roth
authors.forename: C
authors.initials: C
authors.lastname: Scheibelhut
authors.forename: R H
authors.initials: RH
authors.lastname: Bödeker
authors.forename: M
authors.initials: M
authors.lastname: Brück
authors.forename: B
authors.initials: B
authors.lastname: Niemann
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007430:Intraoperative Care / Q000295:instrumentation / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors