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Intraaortic balloon pump in open heart operations: 10-year follow-up with risk analysis
O E Arafa1, T H Pedersen, J L Svennevig
1Department of Surgery A, Rikshospitalet, Oslo, Norway.
Insights
Intraaortic balloon pump (IABP) use for cardiac failure has high early mortality. However, hospital survivors show good long-term prognosis, especially when IABP is used preoperatively.
Area of Science:
- Cardiology
- Cardiac Surgery
- Mechanical Circulatory Support
Background:
- The intraaortic balloon pump (IABP) is a primary mechanical device for managing perioperative cardiac failure.
- High mortality rates are associated with its use in complex cardiac surgical patients.
Purpose of the Study:
- To analyze prognostic predictors and long-term survival in patients requiring perioperative intraaortic balloon pump support.
- To identify factors influencing early and late mortality after cardiac operations with IABP.
Main Methods:
- Retrospective analysis of 344 patients undergoing cardiac operations requiring perioperative IABP (1980-1989).
- Logistic and Cox regression analyses were used to identify predictors of early (30-day) and late death.
- Hospital survivors were followed for a mean of 7.45 years.
Main Results:
- The early mortality rate was 52.6%. Preoperative serum creatinine, ejection fraction, perioperative myocardial infarction, and timing of IABP insertion predicted early death.
- Timing of IABP insertion, perfusion time, and preoperative creatinine predicted late death among survivors.
- Ten-year survival was 22.04%; preoperative IABP use was associated with significantly improved survival.
Conclusions:
- Early mortality in patients receiving an intraaortic balloon pump is substantial.
- Hospital survivors demonstrate a favorable long-term prognosis.
- Liberal preoperative use of IABP in high-risk patients may improve both short- and long-term survival outcomes.
Background:
The intraaortic balloon pump (IABP) is the primary mechanical device used for perioperative cardiac failure.
Methods:
We analyzed the prognostic predictors and long-term survival of 344 patients undergoing cardiac operations who required the perioperative use of an IABP at our institution from January 1980 to December 1989. Hospital survivors (163 patients) were followed up for a mean of 7.45 years (range, 1 month to 15.3 years); cumulative follow-up included 1,167 patient-years.
Results:
The early mortality rate was 52.6% (181 patients). From parameters available at the time of IABP insertion, logistic regression analysis identified preoperative serum creatinine level, left ventricular ejection fraction, perioperative myocardial infarction, timing of IABP insertion, and indication for operation as independent predictors of early (30-day) death (p < 0.05). Cox regression analysis of hospital survivors identified timing of IABP insertion, perfusion time, and preoperative serum creatinine level as independent prognostic factors for late death (p < 0.05), whereas patient age was only marginally significant (p < 0.06). There was no association between IABP-related complications and death. Survival analysis demonstrated a 10-year actual survival rate of 22.04% +/- 0.023%, with 57 patients still at risk and significantly improved survival among those who received an IABP before operation (p < 0.02).
Conclusions:
The early mortality rate in patients who received an IABP was high. Hospital survivors had a relatively good long-term prognosis. The significantly better short- and long-term survival of patients who received an IABP before operation may justify more liberal preoperative use of the IABP in high-risk patients.