Ramnarine Ian R, Grayson Antony D, Dihmis Walid C, Mediratta Neeraj K, Fabri Brian M, Chalmers John A C
Department of Cardiothoracic Surgery, The Cardiothoracic Centre, Liverpool, UK.
Eur J Cardiothorac Surg. 2005 May;27(5):887-92. doi: 10.1016/j.ejcts.2005.02.001.
The relationship between the timing of intra-aortic balloon pump (IABP) support and surgical outcome remains a subject of debate. Peri-operative mechanical circulatory support is commenced either prophylactically or after increasing inotropic support has proved inadequate. This study evaluates the effect timing of IABP support on the 1-year survival of patients undergoing cardiac surgery.
From April 1997 to September 2002, 7698 consecutive cardiac surgical procedures were performed. This included 5678 isolated coronary artery bypasses (CABGs), 1245 isolated valve procedures and 775 simultaneous CABG and valve procedures. IABP support was required in 237 patients (3.1%). Twenty-seven patients (0.35%) were classed as high-risk and received preoperative IABP support, 25 patients (0.32%) were haemodynamically compromised and required preoperative IABP support, 120 patients (1.56%) required intra-operative IABP support, and 65 patients (0.84%) required post-operative IABP support. Multiple variables were offered to a Cox proportional hazards model and significant predictors of 1-year survival were identified. These were used to risk adjust Kaplan-Meier survival curves.
1-year follow-up was complete and 450 deaths (5.8%) were recorded. The significant independent predictors of increased mortality at 1-year (P<0.05, HR=hazard ratio) were post-operative renal failure (HR=3.5), increasing EuroSCORE (HR=1.2), post-operative myocardial infarction (HR=3.7), post-operative IABP (HR=4.1) intra-operative IABP (HR=2.8), post-operative stroke (HR=2.5), increasing number of valves (HR=1.6), ejection fraction <30% (HR=1.3) and triple-vessel disease (HR=1.3). After risk-adjustment, 1-year survival for patients who required intra-operative IABP support was significantly greater than for those patients who required IABP support in the post-operative period.
Patients who warrant IABP support in the post-operative setting have a significantly increased mortality at 1-year when compared to any other group. Therefore, earlier IABP support as part of surgical strategy may help to improve the outcome.
主动脉内球囊反搏（IABP）支持的时机与手术结果之间的关系仍是一个有争议的话题。围手术期机械循环支持可预防性开始，也可在增加的正性肌力支持被证明不足后开始。本研究评估IABP支持时机对心脏手术患者1年生存率的影响。
从1997年4月至2002年9月，连续进行了7698例心脏手术。其中包括5678例单纯冠状动脉旁路移植术（CABG）、1245例单纯瓣膜手术和775例同期CABG和瓣膜手术。237例患者（3.1%）需要IABP支持。27例患者（0.35%）被归类为高危患者并接受术前IABP支持，25例患者（0.32%）血流动力学不稳定且需要术前IABP支持，120例患者（1.56%）需要术中IABP支持，65例患者（0.84%）需要术后IABP支持。将多个变量纳入Cox比例风险模型，并确定1年生存的显著预测因素。这些因素用于对Kaplan-Meier生存曲线进行风险调整。
完成了1年随访，记录到450例死亡（5.8%）。1年时死亡率增加的显著独立预测因素（P<0.05，HR=风险比）为术后肾衰竭（HR=3.5）、欧洲心脏手术风险评估系统（EuroSCORE）增加（HR=1.2）、术后心肌梗死（HR=3.7）、术后IABP（HR=4.1）、术中IABP（HR=2.8）、术后中风（HR=2.5）、瓣膜数量增加（HR=1.6）、射血分数<30%（HR=1.3）和三支血管病变（HR=1.3）。经过风险调整后，需要术中IABP支持的患者1年生存率显著高于需要术后IABP支持的患者。
与其他任何组相比，术后需要IABP支持的患者1年死亡率显著增加。因此，作为手术策略的一部分，更早进行IABP支持可能有助于改善结果。
