Elective intraaortic balloon counterpulsation in high-risk off-pump coronary artery bypass grafting

Area of Science:

• Cardiovascular Surgery
• Mechanical Circulatory Support
• Nephrology

Background:

• Intraaortic balloon pump (IABP) benefits are known in CABG with cardiopulmonary bypass (CPB).
• The efficacy of elective IABP in high-risk off-pump coronary artery bypass grafting (OPCAB) remains unestablished.
• High-risk criteria include left main stem stenosis >70%, unstable angina, and poor left ventricular function.

Purpose of the Study:

• To evaluate the benefits of elective preoperative IABP insertion in high-risk OPCAB patients.
• To compare outcomes between high-risk OPCAB patients with and without preoperative IABP.
• To assess complications, resource utilization, and mortality.

Main Methods:

• A comparative study of 625 OPCAB patients.
• Group I: 20 high-risk patients with elective preoperative IABP via open technique.
• Group II: 25 similar high-risk patients without preoperative IABP.

Main Results:

• No significant differences in baseline risk factors (Euroscore 5.68) or mean grafts.
• No differences in need for inotropes, ventilation duration, arrhythmias, or cerebrovascular, GI, and infective complications.
• Acute renal failure requiring hemofiltration was significantly higher in Group II (p < 0.05).
• Postoperative IABP was required in 16% of Group II patients.
• Intensive care stay was longer in Group I (p < 0.05), but hospital discharge was earlier.
• No IABP-related complications and no difference in mortality.

Conclusions:

• Routine preoperative IABP insertion in high-risk OPCAB patients reduces acute renal failure incidence.
• Preoperative IABP avoids emergency postoperative insertion and may facilitate earlier hospital discharge.
• Elective IABP is a safe and potentially beneficial strategy for selected high-risk OPCAB patients.