High-Risk Cardiac Surgery

Cardiac Surgery

IABP is a well established mechanical support device for temporary ventricular assistance in the treatment of the failing heart.1 However, correct timing for IABP insertion is a relevant issue, with better outcomes reported after pre-operative IAB insertion compared to intra- or post-operative support for high-risk patients undergoing both on and off pump cardiac surgery.2

Pre-operative IABP:

  • Improves in-hospital mortality3
  • Reduces the incidence of post-op LCOS and MI4
  • Significantly shortens ICU and hospital length of stay5
  • Is a class II recommendation in the ACC/AHA guidelines

PRE-OP IABP REDUCES IN-HOSPITAL COMPLICATIONS

60 high-risk CABG patients:

  • Group A (n=30) received IABP within 2 hrs pre-op
  • Group B (n=30) received IABP before weaning
  • Variable Group A Group B P Value
  • No. of hospital survivors 28 (93.3) 23 (76.6) 0.047
  • Length of IABC support 49.9 +/- 26.7 69 +/- 45.2 0.048
  • Length of Intubation (hrs) 50 +/- 76 59.8 +/- 48 NS
  • Length of stay in ICU (hrs) 111 +/- 72 139 +/- 66 NS
  • Length of hospital stay (days) 10 +/- 3.5 12.2 +/- 3.2 0.043
  • IABP complications 2 (6.6) 1 (3.3) NS
  • Perioperative MI 3 (10) 6 (20) NS
  • Postoperative LVEF (%) 42 +/- 5 33 +/- 5 <0.001

C. Marra, et al. Int. J Artif Organs 2002;25:141-6

Pre-Op IABP reduces mortality by 62%

Pre-Op IABP reduces mortality by 62%

Nwaejike N, et al. D0I:10.1532/HSF98.20091009

Pre-Op IABP reduces LCOS by 55%

Pre-Op IABP reduces LCOS by 55%

Miceli A, et al. ICVTS 2009;9:291-295

1 EuroSCORE directed IABP placement in high-risk patients undergoing cardiac surgery. C Diez, et al. ICVTS 2008;7:389-395

2 Early IABP following perioperative myocardial injury improves hospital and mid-term prognosis. A S Rubino, et al. ICVTS 2009;8:310-315

3 Benefits of the preemptive IABP. N Nwaejike, et al. doi:10.1532/HSF 98.20091009

4 Prophylactic IABP in high-risk patients undergoing CABG. A Miceli, et al. ICVTS 2009;9:291-295

5 The role of intra-aortic counterpulsation in high-risk OPCAB surgery. J T Christenson, et al. J Card Surg 2003;18:286-294

High Risk Cardiac Surgery

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