Long-term survival in patients with postcardiotomy cardiogenic shock requiring an intra-aortic balloon pump (IABP)

Aims: The intra-aortic balloon pump (IABP) is a useful option for treatment of postcardiotomy cardiogenic shock. However, the long-term survival after IABP-therapy in cardiac surgery remains unclear.

Methods: From 2000 to 2007, 552 patients with low-output syndrome who underwent open-heart surgery and had an IABP implanted in OR or ICU within 24 hours from the operation were analyzed retrospectively in short – and long-term follow up. Long term follow up was obtained in 535 patients (97%).

Results: Survival rates at 30 days, 180 days, 1 year and 5 years were 70%, 59%, 57% and 49%, respectively. Significant risk factors for long term survival determined by Kaplan-Meier analysis were as following; female (p=0.0001), intraoperative implantation of IABP (p=0.0001), age ≥70 years (p=0.01), chronic obstructive pulmonary disease (p=0.006), diabetes mellitus (p=0.019), liver cirrhosis (p=0.020), preoperative renal dysfunction (p=0.015), simultaneous coronary and valve surgery (p=0.0001), operation time ≥300min (p=0.0001), CPB time ≥70min (p=0.048), max. CK ≥3000 IU/L (p=0.013), use of noradrenalin (p=0.0001), use of adrenalin (p=0.004), rethoracotomy for bleeding (p=0.003), postoperative dialysis (p=0.0001), stroke (p=0.002), postoperative laparatomy due to gastrointestinal complications (p=0.0001), sepsis (p=0.0001), mechanical ventilation ≥6days (p=0.0001).

Conclusions: Patients requiring an IABP after cardiac surgery have very poor long-term prognosis. In critically ill patients despite IABP-therapy, the use of alternative assist device or heart transplantation may be a key to save those patients.