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Elective intraaortic balloon counterpulsation for high-risk off-pump coronary artery bypass operations
1Division of Cardiothoracic Surgery, Emory University School of Medicine and Clinic, Atlanta, Georgia 30322, USA. christyjenkins@emory.org
Insights
Elective intraaortic balloon counterpulsation (IABP) can help high-risk patients undergo off-pump coronary artery revascularization (OPCAB). This strategy improves hemodynamic stability, enabling safer OPCAB procedures.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Procedures
Background:
- Coronary artery revascularization without cardiopulmonary perfusion (OPCAB) can cause hemodynamic instability due to heart manipulation.
- High-risk patients with complex coronary artery disease and comorbidities often benefit from avoiding cardiopulmonary bypass.
Observation:
- This study reports on 16 high-risk patients undergoing multivessel OPCAB with elective intraaortic balloon counterpulsation (IABP).
- Patients had severe coronary obstruction, ventricular dysfunction, recent myocardial infarction, or cerebrovascular disease.
- The use of IABP was elective and intended to facilitate OPCAB in these high-risk individuals.
Findings:
- Intra-aortic balloon counterpulsation (IABP) improved intraoperative hemodynamic stability in patients undergoing OPCAB.
- The need for inotropic support was virtually eliminated during the procedure.
- No complications related to IABP use were reported; one death occurred in the series.
Implications:
- Selective use of IABP can extend the benefits of OPCAB to high-risk surgical candidates.
- This approach may help avoid dangerous hemodynamic instability associated with heart dislocation in OPCAB.
- IABP may be a valuable tool for facilitating complex OPCAB procedures in select patient populations.
Background:
Dislocations of the heart required for exposure and construction of distal anastomoses often produce hemodynamic instability when performing coronary artery revascularization without using cardiopulmonary perfusion (OPCAB). We report our early experience with elective intraaortic balloon counterpulsation (IABP) to enable and facilitate selected high-risk patients to undergo OPCAB.
Methods:
Sixteen high-risk patients undergoing multivessel OPCAB using elective IABP are reported. The patients were believed to be at increased risk because of the presence of severe proximal multivessel coronary artery obstruction, ventricular dysfunction, recent acute myocardial infarction, cardiomegaly-cardiomyopathy, and documented cerebral vascular disease. The presence of significant comorbid disease also made the avoidance of cardiopulmonary bypass desirable, if at all possible, in all patients.
Results:
The IABP appeared to facilitate the intraoperative management of our series of patients. This was evidenced by improved hemodynamic stability and virtual elimination of the need for inotropic support during the dislocations of the heart needed for exposure and construction of distal anastomoses. There were no complications related to use of IABP. There was one death.
Conclusions:
We believe this strategy to use IABP selectively can allow surgeons to safely extend the benefits of OPCAB procedures to high-risk patients and avoid dangerous hemodynamic instability that otherwise, often occurs.