Related Experiment Videos
Optimal timing of preoperative intraaortic balloon pump support in high-risk coronary patients
J T Christenson1, F Simonet, P Badel
1Department of Cardiovascular Surgery, Hôpital de la Tour, Meyrin-Geneva, Switzerland. jtchristenson@latour.ch
Insights
Preoperative intraaortic balloon pump (IABP) support improves outcomes for high-risk coronary artery bypass grafting patients. Starting IABP therapy 2 hours before surgery is effective, showing no significant outcome differences between timing subgroups.
Area of Science:
- Cardiovascular Surgery
- Mechanical Circulatory Support
Background:
- Preoperative intraaortic balloon pump (IABP) treatment offers benefits in outcomes and cost for high-risk patients undergoing coronary artery bypass grafting (CABG).
- Optimal timing for initiating preoperative IABP support in this patient cohort remained to be determined.
Purpose of the Study:
- To determine the optimal timing for initiating preoperative intraaortic balloon pump (IABP) support in high-risk patients scheduled for coronary artery bypass grafting (CABG).
Main Methods:
- A prospective, randomized study involved 60 high-risk CABG patients meeting specific criteria (e.g., LVEF < 0.30, unstable angina).
- Patients were randomized into a control group (no IABP) or IABP groups receiving therapy 2, 12, or 24 hours preoperatively.
- Key inclusion criteria included left ventricular ejection fraction < 0.30, unstable angina, reoperation, or left main stenosis > 70%.
Main Results:
- Cardiopulmonary bypass time was reduced in IABP groups compared to controls.
- Postoperative cardiac index was significantly higher, and low cardiac output incidence was significantly lower in patients receiving preoperative IABP.
- Intubation time and intensive care unit/hospital length of stay were reduced in IABP groups, with one death in the IABP group versus six in the control group.
Conclusions:
- Preoperative IABP therapy demonstrates significant benefits for high-risk CABG patients, including improved cardiac function and reduced complications.
- No significant differences in outcomes were observed between the different preoperative IABP timing subgroups (2, 12, or 24 hours).
- IABP therapy can be initiated as early as 2 hours preoperatively, establishing an optimal timing strategy.
Background:
Beneficial effects of preoperative intraaortic balloon pump (IABP) treatment, on outcome and cost, in high-risk patients who have coronary artery bypass grafting have been demonstrated. We conducted a prospective, randomized study to determine the optimal timing for preoperative IABP support in a cohort of high-risk patients.
Methods:
Sixty consecutive high-risk patients who had coronary artery bypass grafting (presenting with two or more of the following criteria: left ventricular ejection fraction less than 0.30, unstable angina, reoperation, or left main stenosis greater than 70%) entered the study. Thirty patients did not receive preoperative IABP (controls), 30 patients had preoperative IABP therapy starting 2 hours (T2), 12 hours (T12), or 24 hours (T24), by random assignment, before the operation. Fifty patients had preoperative left ventricular ejection fraction mean, less than 0.30 (less than 0.26+/-0.08), (n = 40) unstable angina, 28% (n = 17) left main stenosis, and 32% (n = 19) were reoperations.
Results:
Cardiopulmonary bypass was shorter in the IABP groups. There was one death in the IABP group and six in the control group. The complication rate for IABP was 8.3% (n = 5) without group differences. Cardiac index was significantly higher postoperatively (p<0.001) in patients with preoperative IABP treatment compared with controls. There were no significant differences between the three IABP subgroups at any time. The incidence of postoperative low cardiac output was significantly lower in the IABP groups (p<0.001). Intubation time, length of stay in the intensive care unit and the hospital was shorter in the IABP groups (p = 0.211, p<0.001, and p = 0.002, respectively). There were no differences between the IABP subgroups in any of the studied variables.
Conclusions:
The beneficial effect of preoperative IABP in high-risk patients who have coronary artery bypass grafting was confirmed. There were no differences in outcome between the subgroups; therefore, at 2 hours preoperatively, IABP therapy can be started.