The use of prophylactic intra-aortic balloon pump in high-risk patients undergoing coronary artery bypass grafting


Autoři: Ken Nakamura aff001;  Azumi Hamasaki aff002;  Tetsuro Uchida aff002;  Kimihiro Kobayashi aff001;  Ri Sho aff003;  Cholsu Kim aff001;  Hideaki Uchino aff001;  Takao Shimanuki aff001;  Mitsuaki Sadahiro aff002
Působiště autorů: Division of Cardiovascular Surgery, Nihonkai General Hospital, Sakata, Japan aff001;  Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan aff002;  Department of Public Health, Yamagata University Faculty of Medicine, Yamagata, Japan aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224273

Souhrn

Objective

Intra-aortic balloon pump (IABP) is one of the most commonly used mechanical circulatory assist devices for high-risk patients undergoing cardiac surgery. In an effort to validate previously reported clinical outcomes, we describe the preoperative characteristics and outcomes of patients who underwent prophylactic IABP in high-risk patients undergoing coronary artery bypass grafting (CABG).

Design

A prospective observational study

Methods

From 2005 to 2017, 471 patients underwent either isolated or combined CABG at our institution. Of those, 393 patients underwent isolated CABG and were included for the analysis. Eighty-five patients (22%) were considered high-risk and underwent prophylactic IABP, with subsequent review of surgical morbidity and mortality rates.

Results

The 30-day postoperative mortality (prophylactic IABP group vs non prophylactic IABP group: 0% vs 1.6%, p = 0.589) and major adverse cardiac or cerebrovascular events (5.9% vs 3.3%, p = 0.333) were not significantly different between the two groups. Prolonged mechanical ventilation (>72 hours) (12.5% vs 4.2%, p = 0.014) occurred more frequently in the prophylactic IABP group.

Conclusions

No IABP-related complications were noted, emphasizing that the use of prophylactic IABP in high-risk patients undergoing CABG is an acceptable option.

Klíčová slova:

Cardiac surgery – Coronary artery bypass grafting – Intensive care units – Prophylaxis – Surgeons – Surgical and invasive medical procedures – Vascular surgery – Cardiac rehabilitation


Zdroje

1. Christenson JT, Licker M, Kalangos A. The role of inra-aortic counterpulsation in high-risk OPCAB surgery: a prospective randomized study. J Card Surg.2003;18:286–294 doi: 10.1046/j.1540-8191.2003.02030.x 12869172

2. Theologou T, Bashir M, Rengarajan A, Khan O, Spyt T, Richens Det al. Preoperative intra aortic balloon pump in patients undergoing coronary artery bypass grafting. Cochrane Database Syst Rev. 2011;1:CD004472. doi: 10.1002/14651858.CD004472.pub3 21249662

3. Kellum JA, Bellomo R, Ronco C, Mehta R, Clark W, Levin NW. The 3rd International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI). Int J Artif Organs. 2005;28:441–4. 15883957

4. Creatinine Kinetics and the Definition of Acute Kidney Injury. Sushrut SW, Joseph VB. J Am Soc Nephrol: 2009;20: 672–679. doi: 10.1681/ASN.2008070669 19244578

5. Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CEet al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care 2014;18:658. doi: 10.1186/s13054-014-0658-y 25475522

6. Dyub AM, Whitlock RP, Abouzahr LL, Cina CS. Preoperative intra-aortic balloon pump in patients undergoing coronary bypasss surgery: A systematic review and meta-analysis. J Card Surg.2008;23:79–86. doi: 10.1111/j.1540-8191.2007.00499.x 18290898

7. Field ML, Rengarajan A, Khan O, Spyt T, Richens D. Preoperative intra-aortic balloon pumps in patients undergoing coronary artery bypass grafting. Cochrane Database Syst Rev. 2007;1:CD004472.

8. Sa MP, Ferraz PE, Escobar RR, Martins WN, Nunes EO, Vasconcelos FPet al. Prophylactic intra-aortic balloon pump in high-risk patients undergoing coronary artery bypasss surgery: a meta-analysis of randomized controlled trials. Coron Artery Dis 2012;23:480–486 doi: 10.1097/MCA.0b013e328358784d 22954753

9. Parissis H, Leothinidis M, Akbar MT, Apostolakis E, Dougenis D. The need for intra aortic balloon pump support following open heart surgery: Risk analysis and outcome. J Cardiothorac Surg. 2010;5:20. doi: 10.1186/1749-8090-5-20 20367880

10. Elahi MM, Chetty GK, Kirke R, Azeem T, Hartshorne R, Spyt TJ. Complications related to intra-aortic balloon pump in cardiac surgery: A decade later. Eur J Vasc Endovasc Surg.2005;29:591–594. doi: 10.1016/j.ejvs.2005.01.013 15878534

11. Ding W, Ji Q, Wei Q, Shi Y, Ma R, Wang C. Prophylactic application of an intra-aortic balloon pump in high-risk patients undergoing off-pump coronary artery bypass grafting. Cardiology. 2015;131:109–115. doi: 10.1159/000377720 25895517

12. Shi M, Huang J, Pang L, Wang Y. Preoperative insertion of an intra-aortic balloon pump improved the prognosis of high-risk patients undergoing off-pump coronary artery bypass grafting. J Int Med Res 2011;39:1163–1168. doi: 10.1177/147323001103900404 21986118

13. Rampersad PP, Udell JA, Zawi R, Ouzounian M, Overgaard CB, Sharma V, et al. Preoperative Intraaortic Balloon Pump Improves Early Outcomes Following High-Risk Coronary Artery Bypass Graft Surgery: A Meta-Analysis of Randomized Trials and Prospective Study Design. J Invasive Cardiol. 2018;30:2–9. 28915508

14. Poirier Y, Voisine P, Plourde G, Rimac G, Barria Perez A, Costerousse O, et al. Efficacy and safety of preoperative intra-aortic balloon pump use in patients undergoing cardiac surgery: a systematic review and meta-analysis. Int J Cardiol. 2016;207:67–79. doi: 10.1016/j.ijcard.2016.01.045 26797334

15. Wang J, Yu W, Gao M, Gu C, and Yu Y. Preoperative Prophylactic Intraaortic Balloon Pump Reduces the Incidence of Postoperative Acute Kidney Injury and Short-Term Death of High-Risk Patients Undergoing Coronary Artery Bypass Grafting: A Meta-Analysis of 17 Studies. Ann Thorac Surg 2016;101:2007–19 doi: 10.1016/j.athoracsur.2015.10.078 27045229


Článek vyšel v časopise

PLOS One


2019 Číslo 10