title: Elective use of intra-aortic balloon pump during aortic valve replacement in elderly patients to reduce postoperative cardiac complications.
abstract: This is a retrospective cohort study to determine if routine intra-aortic balloon pump (IABP) placement prior to aortic valve replacement in elderly patients with severe aortic stenosis without significant coronary artery stenosis reduces cardiac complications. Participants were patients aged ≥70 years without significant coronary stenosis, who had severe aortic stenosis, and were undergoing isolated aortic valve replacement. Our primary endpoint was postoperative cardiac morbidity rate as a composite of the adverse cardiac events: elevated creatine kinase with muscle and brain subunits (CK-MB)/CK (>5%), fatal ventricular arrhythmias requiring therapy, or catecholamine index of >10. Eighteen patients had elective IABP insertion prior to surgery, and 16 patients had no planned IABP insertion. One patient died (5.6%) in the elective IABP group (P = 1.0 compared with the non-IABP group). The overall rate of in-hospital death was 2.9% (1/34). In the non-IABP group, one patient had rescue IABP insertion after surgery (6.3%). The elective IABP group had a significantly lower cardiac morbidity rate than the non-IABP group (44.4 vs. 87.5%, respectively, P = 0.013). According to multivariate analysis using a logistic European system for cardiac operative risk evaluation value of >10% to define increased morbidity, elective IABP use significantly reduced cardiac morbidity (odds ratio, 0.11; 95% confidence interval, 0.02-0.67; P = 0.016). Additionally, the elective IABP group was more likely to show low CK-MB/CK than the non-IABP group (4.1 ± 1.9% vs. 6.1 ± 3.1%, respectively, P = 0.026). We concluded that among elderly aortic valve replacement patients without significant coronary artery stenosis, elective IABP use may reduce the incidence of major adverse cardiac events.
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Osaka, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Nakahira
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Sawai
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Minami
mesh_terms: D000367:Age Factors; D000368:Aged; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006331:Heart Diseases / Q000209:etiology / Q000517:prevention & control*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Adverse cardiac event; Aortic valve replacement; Intra-aortic balloon pump