Implantation of an Intraaortic Balloon Pump for Preoperative Cardiogenic Shock SCAI Stages B to C: A Propensity Score–Matched Analysis

Background: Preoperative cardiogenic shock is associated with a poor prognosis in cardiac surgery. However, for patients who do not progress beyond Society for Cardiovascular Angiography and Interventions (SCAI) classification stage C cardiogenic shock, preoperative implantation of an intra-aortic balloon pump (IABP) is still an accepted tool. Nevertheless, whether preoperative implantation of an IABP affects the outcome of these patients is still debated and was the aim of our work.

Method: We reviewed data from 862 consecutive patients who received an IABP during their stay. Preoperatively, 284 patients were in cardiogenic shock SCAI stage B or C. We divided the cohort into patients with preoperative IABP implantation (pre-IABP group, n = 105) and with intra-/postoperative IABP implantation (control group, n = 105), using 1:1 propensity score matching. In addition, we analyzed prospectively collected demographic and perioperative data, complication profile, short- and long-term survival.

Results: The complexity of surgery in the pre-IABP group did not differ from the control group (1.2 ± 0.5 procedures vs. 1.1 ± 0.3 procedures, p = 0.392). Also, the duration of surgery (pre-IABP 215 ± 79 min vs. control: 227 ± 95 min; p = 0.287) and length of stay on ICU (pre-IABP 290 ± 408 hours vs. control 315 ± 378 hours, p = 0.645) were not different. However, the pre-IABP group had similar rates of postoperative stroke (11.4 vs. 16.2%, p = 0.314), myocardial infarction (2.9 vs. 2.9%, p = 1.000), resuscitation (19.0 vs. 29.5%; p = .077), and dialysis (45.7 vs. 44.8%, p = 0.890) compared with the control group. Interestingly, patients in the pre-IABP group were less likely to require an upgrade to extracorporeal life support (ECLS) (19.0 vs. 31.4%, p = .039) and rethoracotomy (10.5 vs. 27.6%, p = 0.002) compared with the control group. However, 30-day mortality did not differ between the two groups (pre-IABP 34.3% vs. control 40.0%, p = 0.475). Cumulative survival rates at 3, 6, and 12 months for the per-IABP and the control group were 60.0% versus 51.4%, 52.4% versus 50.5%, and 52.4% versus 48.5%, respectively (log-rank test p = 0.693).

Conclusion: In patients with preoperative cardiogenic shock SCAI stage B to C, our study did not demonstrate a short- or long-term survival benefit for preoperative implantation of an IABP compared with intra-/postoperative implantation. However, preoperative IABP implantation resulted in a lower perioperative need for ECLS and a lower rate of rethoracotomy.

Publication History

Article published online:
03 February 2022