ObjectiveTo evaluate the clinical efficacy of preoperative intra-aortic balloon pump (IABP) insertion in patients with off-pump coronary artery bypass grafting (OPCABG) surgery.MethodsThe clinical data of 130 patients who underwent OPCABG with IABP from 2015 to 2019 in our hospital were retrospectively analyzed. The patients were divided into two groups, including a group A (preoperative IABP insertion, n=72) and a group B (emergent IABP insertion, n=58). There were 42 males and 30 females in the group A with an average age of 60-72 (65.0±5.2) years. There were 32 males and 26 females in the group B with an average age of 56-73 (62.3±7.6) years. The in-hospital mortality rate and prognosis were compared between the two groups.ResultsThe in-hospital mortality rate in the group A (4.2%) was significantly lower than that in the group B (12.1%, P=0.002). The IABP time (40.8±10.3 min vs. 65.3±15.6 min), mechanical ventilation time (18.7±6.1 min vs. 48.7±10.5 min) and ICU stay time (48.1±7.8 min vs. 90.2±21.3 min) of the group A were shorter than those of the group B (P<0.05). The number of bypass grafts was not significantly different between the two groups (3.6±1.2 vs. 3.8±1.0, P=0.387). Multivariable logistic regression analysis indicated that independent risk factors for in-hospital mortality included age [OR=1.04, 95%CI (1.01, 1.10), P=0.030], female [OR=2.56, 95%CI (1.53, 6.12), P=0.000] and left ventricular end-diastolic diameter [OR=1.05, 95%CI (1.01, 1.13), P=0.030]. Preoperative IABP support was the protective factor [OR=0.17, 95%CI (0.01, 0.78), P=0.005].ConclusionPatients undergoing OPCABG with preoperative IABP insertion may reduce in-hospital mortality rate and improve outcomes.
Objective To analyze the results of intra-aortic balloon pump (IABP) support in patients receiving coronary artery bypass graft (CABG) and the risk factors of postoperative death. Methods The clinical data of 334 patients undergoing CABG procedure and receiving IABP support in Fuwai Hospital from January 1999 to April 2012 were retrospectively analyzed. According to the IABP insertion timing, the patients were divided into three groups: pre-, intra- and postoperative IABP groups. There were 45 males and 11 females aged 60.5±10.7 years in the preoperative IABP group, 84 males and 23 females aged 61.1±8.4 years in the intraoperative IABP group and 119 males and 52 females aged 61.4±8.5 years in the postoperative IABP group.Outcomes of the three groups were compared, including mortality, major complications, ICU stay, hospital stay and total costs. Multivariable logistic regression analysis was used to predict independent risk factors for postoperative in-hospital death. Results The total in-hospital mortality was 16.8% (56/334). Mortality was significantly different among the pre-, intra- and postoperative IABP groups (3.6% vs.23.4%vs. 17.0%, P=0.006). There was no significant difference in complications among the three groups (P=0.960). Multivariable logistic regression analysis indicated that independent risk factors for postoperative mortality included old age (OR=1.05, P=0.040), female (OR=3.34, P<0.001) and increasing left ventricular end-diastolic diameter (LVEDD,OR=1.06, P=0.040). Preoperative IABP support was protective factor (OR=0.10, P=0.050). Conclusion The results of IABP support in CABG patients are satisfactory, and patients with preoperative IABP have a lower mortality. Risk factors for postoperative death include old age, female and increasing LVEDD. Preoperative IABP support is a protective factor.
ObjectiveTo summarize the experience of intra-aortic balloon pump (IABP) application on coronary artery bypass grafting（CABG）during perioperative period. MethodsWe retrospectively analyzed the data of 82 patients undergoing simple CABG operation in Wuhan Asia Heart Hospital between January 2011 and December 2013. There were 50 male and 32 female patients at age of 49-75 (63.6±11.5) years. The patients were divided into three groups including a group A (12 patients, preoperative-placed IABP), a group B(39 patients , postoperative active placed IABP), and a group C (31 patients, postoperative passive placed IABP). The clinical effects of the three groups were compared. ResultsThere were significantly statistic differences in sequential organ failure assessment (SOFA) score after postoperative 48 hours, ventilator supporting time, IABP supporting time, catecholamine drug usage time, infection incidence, incidence of ventricular arrhythmia, ICU retention time, postoperative hospital stay, CBP usage rate, and postoperative mortality (P<0.05) among the three groups with worse effect in the group C. ConclusionTaking IABP support during CABG perioperative period is an effective treatment. Preventively preoperative and actively postoperative placing IABP can improve the treatment effects significantly. Therefore, patients should apply CABG as soon as possible without hesitation when IABP indications occur.
ObjectiveTo systematically review the efficacy and safety of prophylactic use of intra-aortic balloon pump counterpulsation (IABP) before coronary artery bypass grafting (CABG) in high risk patients. MethodsDatabases including The Cochrane Library (Issue 2, 2014), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were electronically searched from inception to July 2014, to collect randomized controlled trials (RCTs) and cohort studies about prophylactic use of IABP before CABG in high risk patients. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.2 software. ResultsA total of 6 RCTs and 6 cohort studies involving 1 359 patients were included, of which 633 prophylactically used IABP before CABG (the IABP group) and 736 didn't prophylactically use IABP before CABG (the control group). The results of meta-analysis showed that: compared with the control group, prophylactic use of IABP could significantly reduce perioperative mortality (RCT: OR=0.15, 95%CI 0.06 to 0.38, P<0.000 1; cohort study: OR=0.36, 95%CI 0.19 to 0.67, P=0.001) and postoperative LCOS (RCT: OR=0.23, 95%CI 0.12 to 0.43, P<0.000 01; cohort study: OR=0.21, 95%CI 0.10 to 0.43, P<0.000 1); there was no significant difference between two groups in incidence rate of postoperative myocardial infarction (MI) (RCT: OR=0.34, 95%CI 0.10 to 1.11, P=0.07; cohort study: OR=0.56, 95%CI 0.26 to 1.24, P=0.15); the results of combined analyses of RCTs showed that, prophylactic use of IABP could significantly reduce postoperative ICU stay (MD=-42.94, 95%CI -56.11 to -29.76, P<0.000 01) and postoperative hospital stay (MD=-3.83, 95%CI-5.82 to -1.85, P=0.0002), but these differences were not found in the results of combined analyses of cohort studies (MD=-4.68, 95%CI 20.69 to 11.33, P=0.57; MD=-0.77, 95%CI -1.80 to 0.26, P=0.14). ConclusionProphylactic use of IABP before CABG in high risk patients can significantly reduce the perioperative mortality, postoperative LCOS and the length of ICU stay, however it cannot reduce postoperative MI. Due to the limited quantity and quality of included studies, the above conclusions still need to be verified by more high quality studies.