title: Long-term outcomes of coronary artery bypass grafting patients supported preoperatively with an intra-aortic balloon pump.
abstract: OBJECTIVE
  Most studies describing the outcome of coronary artery bypass grafting patients supported preoperatively with an intra-aortic balloon pump (IABP) have reported early results. The purpose of our study was to evaluate the early and long-term results.
  
  
  METHODS
  Of 2658 isolated coronary artery bypass grafting procedures performed from 1996 to 2001, 215 were supported preoperatively with an IABP. The indications for IABP insertion were cardiogenic shock in 18 (8.4%), acute evolving myocardial infarction in 38 (17.7%), clinical instability in 84 (39.1%), and critical coronary lesions in 75 (34.9%).
  
  
  RESULTS
  Operative mortality was 12.6%. The mortality of the cardiogenic shock patients was greater (22.2%; P=.174). Logistic regression analysis showed patient age (odds ratio, 1.057; 95% confidence interval, 1.010-1.108) and cardiopulmonary bypass (CPB) time (odds ratio, 1.020; 95% confidence interval, 1.008-1.031) were associated with increased operative mortality. An increased number of bypass grafts had a protective effect (odds ratio, 0.241; 95% confidence interval, 0.113-0.515). The actual early mortality was lower than the logistic EuroSCORE calculated mortality (12.6% vs 32.8%, P<.0001). The mean follow-up was 8±4 years. The Kaplan-Meier 10-year survival was 49%. The Cox adjusted overall (early and late) survival and major adverse cardiac events-free survival of the different IABP subgroups was similar. Cox analyses showed peripheral vascular disease, off-pump coronary artery bypass surgery, age, CPB time, female gender, and fewer bypass grafts were associated with decreased survival.
  
  
  CONCLUSIONS
  In patients supported preoperatively with an IABP, better early and long-term results were strongly related to younger age, a shorter CPB time, and a greater number of bypass grafts. Avoiding the use of CPB (off pump) in these emergency cases is not recommended.
authors: Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors: Eli
authors: E
authors: Hemo
authors: Department of Cardiothoracic Surgery, Rabin Medical Center, Petach Tiqva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Benjamin
authors: B
authors: Medalion
authors: Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: pevnid@gmail.com.
authors: Rephael
authors: R
authors: Mohr
authors: Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Yossi
authors: Y
authors: Paz
authors: Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Amir
authors: A
authors: Kramer
authors: Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Gideon
authors: G
authors: Uretzky
authors: Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Nachum
authors: N
authors: Nesher
authors: Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Dmitri
authors: D
authors: Pevni
mesh_terms: D000367:Age Factors; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016017:Odds Ratio; D016016:Proportional Hazards Models; D065840:Protective Factors; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome