The Evaluation of Survival in Patients Who Need Intra Aortic Balloon Pump (IABP) after Cardiac Surgery

Document Type : Original Article

Authors

1 Cardiac Surgeon , Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Resident of community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction: Insome cases, assist devices are required to ensure an adequate cardiac output after cardiac surgery. Intra-aortic balloon pump (IABP) is the most commonly used cardiac assist device, which provides first-line support for patients with heart failure. The aim of this study was to determine factors affecting the mortality rate of patients receiving IABP.
Materials & Methods:  In this retrospective cohort study 235 patients requiring LABP support were analyzed over 14 years period (between January 1999 and December 2013) from which 137 patients survived the 30 days follow-up. Perioperative and demographic factors such as age, weight, underlying disease, ejection fraction, ventricular aneurysm and cardiopulmonary bypass and cross clamp time were recorded and analyzed. 
 
Results: The overall operative mortality was reported to be 41.7%. Male-to-female ratio was 131:104 and the mean age of the subjects was 57.58 ± 11.07 years. Early mortality rate was higher among young subjects and those with prolonged CBP (162.71±35.25, P<0.001) and ACC (129.94±54.39, P<0.001). In addition, mortality rate was higher among females (P=0.04). Patients’ weight, comorbidity, preoperative ejection fraction, ventricular aneurysm and stenosis of the left main coronary did not affect the mortality rate (P>0.05).
Conclusion: IABP is a simple, effective method for temporary cardiac support, especially for aged patients. In addition, lower duration of surgery is associated with better surgical outcomes.

Keywords


  1. Kantrowitz A. Origins of intra-aortic balloon pumping. Ann Thorac Surg 1990 , 50:672-74. MacGee E, MacCarthy P, Moazami N. Temporary mechanical circulatory support. In Cardiac Surgery in the Adult. 3rd edition. Edited by: Cohn L. MacGraw Hill New York, Chicago, San Francisco; 2008:507-33.
  2. Katz E, Tunick P, Kronzon I. Observations of coronary flow augmentation and balloon function during intraaortic balloon caounterpulsation using transesophageal echocardiography. Am J Cardiol 1992 :69;1635-39.
  3. Watanabe Y. The effects of blood flows of coronary artery bypass grafts during intra-aortic balloon pumping. J Cardiovasc Surg 1994 , 35:99-102.
  4. Parissis H, Leotsinidis M, Akbar M.T, Apostolakis E, Dougenis D. The need for intra aortic balloon pump support following open heart surgery: risk analysis and outcome. J Cardiothorac Surg. 2010 : 5;5-20.
  5.  Karimi A, Movahedi N, Salehiomran A, Marzban M,  S. H, Yazdanifard P. Mortality in open heart surgery with intraaortic balloon pump support. Asian Cardiovasc Thorac Ann. 2008;16:301-4.
  6. Christenson JT, Cohen M, Ferguson JJ , Freedman RJ, Miller MF, Ohman EM,, et al. Trends in intra aortic balloon counterpulsation complications and outcomes in cardiac surgery. Ann Thorac Surg 2002 ; 74:1086-1090.
  7. Ferguson JJ, Cohen M, Freedman RJ , Stone GW, Miller MF, Joseph DL, et al. The current practice of intra-aortic balloon counterpulsation: Results from the Benchmark Registry. JACC 2001 ; 38:1246-62.
  8. Christenson J, Schmuziger M, Simonet F. Effective surgical management of high-risk coronary patients using preoperative intra-aortic balloon counterpulsation therapy. Cardiovasc Surg 2001; 9:383-90.
  9. Pi K, Block PC, Warner MG, Diethrich EB. Major determinants of survival and nonsurvival of intraaortic balloon pump. Am Heart J 1995 ; 130:849-53.
  10. Hedenmark J, Ahn H, Henze A. Intra-aortic balloon counterpulsation with specific references to determinants of survival. Scand J Thorac Cardiovasc Surgery 1989 , 23:57-62.
  11. Gutfinger DE, Ott RA, Miller M, Selvan A, Codini MA, Alimadadian H, et al. Aggressive preoperative use of intraaortic balloon pump in elderly patients undergoing coronary artery bypass grafting.Ann Thorac Surg. 1999;67:610 –3.
  12. Kantrowitz A, Wasfie T, Freed PS, Rubenfire M, Wajszczuk W, Schork MA, et al. Intraaortic balloon pumping 1967 through 1982: Analysis of complications in 733 patients.Am J Cardiol 1986 , 57:976-983.
  13. Di Lello F, Mullen DC, Flemma RJ, Anderson AJ, Kleinman LH, Werner PH. Results of intraaortic balloon pumping after cardiac surgery: experience with the Percor balloon catheter.Ann Thorac Surg 1988 , 46:442-6.
  14. Ramnarine IR, Grayson AD, Dihmis WC, Mediratta NK, Fabri BM, Chalmers JA. Timing of intra-aortic balloon pump support and 1-year survival.Eur J Cardiothorac Surg 2005 , 27:887-892.
  15. Torchiana DF, Hirsch G, Buckley MJ, Hahn C, Allyn JW, Akins CW, et al.  Intraaortic balloon pumping for cardiac support: Trends in practice and outcome, 1968 to 1995. J Thorac Cardiovasc Surg 1997 , 113:758-69.
  16. Arafa OE, Pedersen TH, Svennevig JL, Fosse E, Geiran OR. Intraaortic balloon pump in open heart operations: 10 year follow up with risk analysis. Ann Thorac Surg 1998 ; 65:741-7.