IABP before cardiac surgery: clinical benefit compared to intraoperative implantation

Aims: The aim of this study was to determine whether in high-risk patients undergoing coronary surgery, preoperative compared to intraoperative intra-aortic balloon counterpulsation (IABP) is advantageous regarding 30-day- and 2-year survival.

Methods: In the years 2004 to 2008, 156 consecutive patients undergoing coronary surgery with IABP support (119 preoperative, 37 intraoperative IABP) were observed. Using the Fisher's exact test, the Wilcoxon and median tests, possible group differences were evaluated according to the distribution of Cohen. After a univariate analysis, models of logistic regression and Cox-regression were build.

Results: Preoperative hemodynamic state and risk profile of the two patient groups were comparable: The group with preoperative IABP had a similar rate of emergencies (21.9% vs. 18.9%), cardiogenic shock (8.4% vs. 10.8), inotropes (8.4% vs. 8.1%) impaired LVEF (30.3% vs. 29.7%) and ventilation (5.9 vs. 5.4) compared to patients with intraoperative IABP. Nevertheless, patients with intraoperative IABP had a significantly higher 30-day mortality (37.8% vs. 5.9%) and 2-year mortality (54.0% vs. 18.1%) compared to patients with preoperative IABP. The logistic regression revealed that patients with intraoperative IABP have a 16-fold higher 30-day mortality rate after coronary surgery (OR: 16.386, 95%-CI: 4.858–55.266) than patients with preoperative IABP. Two-year mortality (OR: 9.317, 95% CI: 3.430 to 25.311) and survival time were significantly better in patients with preoperative IABP therapy.

Conclusions: Considering the significant benefit for patients with preoperative compared to intraoperative IABP, the results of this study indicate a more liberal indication for IABP in high-risk patients before coronary bypass surgery.