Thorac Cardiovasc Surg 2012; 60 - PP56
DOI: 10.1055/s-0031-1297703

Beneficial effect of preoperative intra-aortic balloon pumping in patients with low-ejection fraction undergoing coronary artery bypasses grafting

F Nabawi 1, G Santarpino 1, S Pfeiffer 1, T Fischlein 1
  • 1Klinik für Herzchirurgie – Klinikum Nürnberg, Nürnberg, Germany

Objective: We evaluated the association between the preoperative use of intraaortic balloon pumping in patients with severely impaired left ventricular function (<30%) undergoing coronary artery bypass grafting.

Methods: Records from 4900 patients undergoing isolated coronary artery bypass grafting between December 2001 and December 2010at our institution have been evaluated. We compared the clinical findings after surgery between 210 patients who had a severely impaired left ventricular function (<30%) and received intraaortic balloon pumping preoperatively (group A) and 4690 patients who had a LVEF >30% and did not receive preoperative intraaortic balloon pumping (group B).

Results: Group A patients were significantly older (68.8±11.4 vs. 64.6±13.2, p<0.001), had significantly more comorbid conditions (Euroscore A 13.8±3.2 vs. B 11.8±8.4, p<0.001), and had a significantly higher preoperative recent myocardial infarction (52.4% vs. 21.1%) and emergency indication (32.4% vs. 6.1%) (both p<0.001). No difference were recorded in terms of vessels disease (2.8±0.5 vs. 2.81±0.48, p=0.82), redo (2.4 vs. 3.6p=0.23) and OPCAB (both 5.2%, p=0.54) approach.

Troponin I showed comparable postoperatively leakage: 0.85±0.5 vs. 0.80±0.7, p=0.911. The incidence of in-hospital mortality (11pts-5.2% vs. 165pts-3.5%), perioperative acute myocardial infarction (6pts-2.9% vs. 110pts-2.3%) and low output syndrome (17pts-8.1% vs. 357pts-7.6%) were comparable (p=0.18, 0.38 and 0.44 respectively).

Conclusions: The preoperative use of intraaortic balloon pumping appears to shift patients with severely impaired left ventricular function and higher risk score undergoing coronary artery bypass grafting into a lower-risk category. This is associated with comparable perioperative troponin peak and short-term outcomes similar to patients with a better contractility not receiving intraaortic balloon pumping.