Intra-aortic balloon pump following CABG: 8 years experience

Objectives: Intraaortic balloon pump (IABP) implantation is an established therapy for treatment of left ventricular failure following CABG. However, the outcome of coronary high-risk patients is associated with a high mortality rate and the predictive factors remain unclear.

Methods: Between 01/1998 and 12/2005, 11176 patients underwent isolated CABG surgery at our institution. In 380 (3.4%) patients with either preoperative or intraoperative myocardial infarction (MI) or low cardiac output IABP support was used. Among these, 280 male and 100 female (average age 69±8.8 years, LVEF 47.3±16.6%) received intra- (n=223) or postoperative (n=157) IABP support. To identify predictors of survival patient data were tested in a univariate analysis. Parameters showing significance were further assessed in a multivariate logistic regression risk analysis.

Results: The overall hospital mortality was 35% (n=134). The mortality in patients who received intraoperative IABP was significant lower than in patients with postoperative IABP support (21% vs. 56%, p<0.05). Predictors of survival were the intraoperative occurrence of more then one predefined shock-criterions: catecholamine support, urine output <100ml/h, central venous oxygen saturation <60% and left atrial pressure >15mmHg (OR 3.76 to 24.1) and time of IABP implantation (OR 1.86). The mortality of stable high risk patients with preoperative MI and intraoperative IABP support was 3.2% (n=30).

Conclusions: Intraoperative treatment with IABP decreases hospital mortality. Especially intraoperative elective assignment in stable high risk CABG patients seems to be advantageous regarding the outcome.