title: Single-centre experience with perioperative use of intraaortic balloon pump in cardiac surgery.
abstract: BACKGROUND
  Intraaortic balloon pump (IABP) is frequently used in cardiac surgery in order to prevent or treat low cardiac output syndrome. Although being widely used and forming the first line therapy in these haemodynamically unstable patients despite maximal medication, optimal timing for IABP insertion is still discussed. This retrospective study evaluates hospital outcomes of patients receiving IABP at preoperative, intraoperative and postoperative periods during cardiac surgery.
  
  
  METHODS
  Between 2006 and 2012, 2196 patients underwent open cardiac surgery in our centre. IABP was used in 121 (5.4%) patients. Nine patients had preoperative IABP insertion, 76 patients (62.8%) had intraoperative insertion to ease weaning from cardiopulmonary bypass, and 36 patients (29.8%) had postoperative insertion in the intensive care unit mainly due to refractory haemodynamic instability. Hospital outcomes of these 121 patients were analysed retrospectively.
  
  
  RESULTS
  The majority of the patients were male (men 89, 73.6% and women 32, 26.4%; mean age was 65.9±11.5 years). Among the cohort 87 (71.9%) underwent isolated coronary artery bypass surgery (CABG) and the rest (34 patients, 28.1%) were operated for valve disease with/without CABG or for CABG with carotid endarterectomy, left ventricular aneurysm repair, post myocardial infarction ventricular septal defect or pathologies involving ascending aorta. The overall hospital mortality of the whole cohort was 27.3%. Mortality rates according to IABP timing were 33.3%, 19.7% and 41.7% for pre, intra and postoperative insertion, respectively. Logistic regression analysis identified female gender, low ejection fraction (<30%), complex surgery and postoperative insertion as risk factors for mortality.
  
  
  CONCLUSIONS
  IABP insertion timing in cardiac surgery is crucial and many reports advocate early insertion since patient outcomes are poor for late insertions. This single centre study also confirms that the least favourable results are among patients with postoperative IABP insertion.
authors.affiliation: Atatürk Training and Research Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Electronic address: asliastan@yahoo.com.
authors.forename: Aslihan
authors.initials: A
authors.lastname: Kucuker
authors.affiliation: Atatürk Training and Research Hospital, Cardiovascular Surgery Department, Ankara, Turkey.
authors.forename: Levent
authors.initials: L
authors.lastname: Cetin
authors.affiliation: Atatürk Training and Research Hospital, Cardiovascular Surgery Department, Ankara, Turkey.
authors.forename: Seref Alp
authors.initials: SA
authors.lastname: Kucuker
authors.affiliation: Atatürk Training and Research Hospital, Cardiovascular Surgery Department, Ankara, Turkey.
authors.forename: Mecit
authors.initials: M
authors.lastname: Gokcimen
authors.affiliation: Atatürk Training and Research Hospital, Cardiovascular Surgery Department, Ankara, Turkey.
authors.forename: Mete
authors.initials: M
authors.lastname: Hidiroglu
authors.affiliation: Atatürk Training and Research Hospital, Cardiovascular Surgery Department, Ankara, Turkey.
authors.forename: Aysegul
authors.initials: A
authors.lastname: Kunt
authors.affiliation: Atatürk Training and Research Hospital, Cardiovascular Surgery Department, Ankara, Turkey.
authors.forename: Fethi
authors.initials: F
authors.lastname: Saglam
authors.affiliation: Atatürk Training and Research Hospital, Cardiovascular Surgery Department, Ankara, Turkey.
authors.forename: Erol
authors.initials: E
authors.lastname: Sener
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass / Q000379:methods*; D005260:Female; D006331:Heart Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011300:Preoperative Care / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D012737:Sex Factors; D013318:Stroke Volume; D013997:Time Factors
keywords: Cardiac surgery; Circulatory support; Extrocorporeal balloon counterpulsation; Intraaortic balloon pump; Low cardiac output syndrome