The effects of preventative intra-aortic balloon pump in high-risk patients undergoing coronary artery bypass grafting / 中华胸心血管外科杂志

ABSTRACT

ObjectiveTo compare the effects of preventative intra-aortic balloon pump (IABP) insertion with intra-or post-operative IABP insertion in high-risk patients undergoing coronary artery bypass grafting (CABG).MethodsFrom Jan 2008 to May 2011,one hundred and four patients received CABG or off-pump CABG (OPCABG) and IABP therapy in our hospital.The enrolled criteria of IABP insertion included left ventricular ejection fraction (EF) less than 0.40,unstable angina,AMI,left main stenosis,emergency CABG,refractory ventricular arrhythmia.Group1 included thirty eight patients with preoperative IABP insertion,thirty one for intra-operative IABP insertion ( group 2 ) and thirty four for postoperative IABP insertion ( group 3 ).The indications for IABP insertion for group 2 and 3 were unstable hemodynamics,failure to wean off cardiopulmonary bypass and low output syndrome during or after operation.Clinical data including operative mortality,ventricular fibrillation,chest drainage,hospital stay,ICU stay,ventilator supporting time,IABP supporting time,EF improvement rate,mechanical assist device and Inotropic drugs utilizations were analyzed among three groups.ResultsGroup 1 demonstrated good therapeutic results.There were significant statistic differences in operative mortality ( group 1 2.6％,group 2 12.9％,Group 3 47.1％),hospital stay[group 1 (23.6 ± 9.8) days,group 2 (21.5 ±9.7) days,group 3 (28.9 ±13.3) days],ICU stay[group 1 (2.3 ± 1.1 ) days,group 2 (3.5 ± 1.5 ) days,group 3 (5.2 ± 3.4) days],ventilator supporting time [group 1 (29.5 ± 23.0) hours,group 2 (38.7 ± 20.6) hours,group 3 (84.1 ± 48.0) hours],IABP supporting time [group 1 (77.0 ± 43.7 ) hours,group 2 ( 93.8 ± 44.8 ) hours,group 3 ( 121.5 ± 71.7 ) hours],EF improvement rate [group 1 (7.5 ± 7.2),group 2 ( 8.5 ± 7.5 ),group 3 (2.0 ± 6.7)],inotropic drugs utilization[group 1 ( 3.7 ± 4.9) days,group2 (6.2±4.6) days,group3 (10.8±5.4) days](P＜0.05).ConclusionComparing with intra- or post-operative IABP insertion,high-risk patients undergoing CABG could significantly benefit from preventative IABP insertion.Early IABP insertion was recommended for high-risk patients undergoing coronary artery bypass grafting.