title: Emergency Off-Pump Coronary Artery Bypass Graft Surgery for Patients on Preoperative Intraaortic Balloon Pump.
abstract: BACKGROUND
  The aim of this study was to investigate early and long-term outcomes of patients with acute coronary syndrome preoperatively requiring intraaortic balloon pump support who underwent emergency off-pump coronary artery bypass graft surgery.
  
  
  METHODS
  One hundred and fifteen patients on preoperative intraaortic balloon pump receiving emergency off-pump coronary artery bypass graft surgery over an 11-year period were evaluated. The median age was 71 years (range, 33 to 87). Acute myocardial infarction and unstable angina were present in 54 patients (47.0%) and 61 patients (53.0%), respectively. Left main disease and triple-vessel disease without left main involvement were present in 74 patients (64.3%) and 33 patients (28.7%), respectively.
  
  
  RESULTS
  There were 3 perioperative deaths. Complete surgical revascularization was accomplished in 82 patients (71.3%), and in situ internal thoracic artery graft was used in 96 (83.5%). Late survival, freedom from major adverse cardiac and cerebrovascular events, and freedom from repeat revascularization rates at 5 years were 83.3%, 73.5%, and 84.2%, respectively. The Cox multivariate prognostic predictors of total mortality were preoperative renal impairment (hazard ratio [HR] 7.90; 95% confidence interval [CI]: 3.06 to 20.4) and low ejection fraction (HR 0.94, 95% CI: 0.88 to 0.99). The multivariate risk predictors of major adverse cardiac and cerebrovascular events were preoperative renal impairment (HR 2.68, 95% CI: 1.00 to 7.19) and peripheral vascular disease (HR 2.81, 95% CI: 1.05 to 7.51), and complete revascularization was protective (HR 0.39, 95% CI: 0.19 to 0.81). The multivariate risk factor of repeat revascularization was previous percutaneous coronary intervention (HR 3.26, 95% CI: 1.14 to 9.33), and complete surgical revascularization was also protective (HR 0.30, 95% CI: 0.11 to 0.85).
  
  
  CONCLUSIONS
  Off-pump coronary artery bypass graft surgery is a feasible option for patients requiring preoperative intraaortic balloon pump support.
authors.affiliation: Department of Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo City, Aichi. Electronic address: hisato.ito@gmail.com.
authors.forename: Hisato
authors.initials: H
authors.lastname: Ito
authors.affiliation: Department of Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo City, Aichi.
authors.forename: Toru
authors.initials: T
authors.lastname: Mizumoto
authors.affiliation: Department of Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo City, Aichi.
authors.forename: Hironori
authors.initials: H
authors.lastname: Tempaku
authors.affiliation: Department of Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo City, Aichi.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Fujinaga
authors.affiliation: Department of Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo City, Aichi.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Sawada
authors.affiliation: Department of Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo City, Aichi.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Teranishi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Mie University, Tsu, Mie, Japan.
authors.forename: Hideto
authors.initials: H
authors.lastname: Shimpo
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D004630:Emergencies; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention