Department of Cardiopulmonary Bypass, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Artif Organs. 2009 Aug;33(8):587-92. doi: 10.1111/j.1525-1594.2009.00788.x. Epub 2009 Jun 28.
Although intra-aortic balloon pumping (IABP) has been used widely as a routine cardiac assist device for perioperative support in coronary artery bypass grafting (CABG), the optimal timing for high-risk patients undergoing first-time CABG using IABP is unknown. The purpose of this investigation is to compare preoperative and preventative IABP insertion with intraoperative or postoperative obligatory IABP insertion in high-risk patients undergoing first-time CABG. We reviewed our IABP patients' database from 2002 to 2007; there were 311 CABG patients who received IABP treatment perioperatively. Of 311 cases, 41 high-risk patients who had first-time on-pump or off-pump CABG (presenting with three or more of the following criteria: left ventricular ejection fraction less than 0.45, unstable angina, CABG combined with aneurysmectomy, or left main stenosis greater than 70%) entered the study. We compared perioperatively the clinical results of 20 patients who underwent preoperative IABP placement (Group 1) with 21 patients who had obligatory IABP placement intraoperatively or postoperatively during CABG (Group 2). There were no differences in preoperative risk factors, except left ventricular aneurysm resection, between the two groups. There were no differences in indications for high-risk patients between the two groups. The mean number of grafts was similar. There were no significant differences in the need for inotropes, or in cerebrovascular, gastrointestinal, renal, and infective complications postoperatively. There were no IABP-related complications in either group. Major adverse cardiac event (severe hypotension and/or shock, myocardial infarction, and severe hemodynamic instability) was higher in Group 2 (14 [66.4%] vs. 1 [5%], P < 0.0001) during surgery. The time of IABP pumping in Group 1 was shorter than in Group 2 (72.5 +/- 28.9 h vs. 97.5 +/- 47.7 h, P < 0.05). The duration of ventilation and intensive care unit stay in Group 1 was significantly shorter than in Group 2, respectively (22.0 +/- 1.6 h vs. 39.6 +/- 2.1 h, P < 0.01 and 58.0 +/- 1.5 h vs. 98.5 +/- 1.9 h, P < 0.005). There were no differences in mortality between the two groups (n = 1 in Group 1 and n = 3 in Group 2). Preoperative and preventative insertion of IABP can be performed safely in selected high-risk patients undergoing CABG, with results comparable to those in patients who received obligatory IABP intraoperatively and postoperatively. Therefore, earlier IABP support as part of surgical strategy may help to improve the outcome in high-risk first-time CABG patients.
主动脉内球囊反搏（IABP）已广泛用作冠状动脉旁路移植术（CABG）围手术期支持的常规心脏辅助装置，但对于首次接受 CABG 的高危患者使用 IABP 的最佳时机尚不清楚。本研究旨在比较高危患者首次接受 CABG 时，术前和预防性 IABP 插入与术中或术后强制性 IABP 插入的效果。我们回顾了 2002 年至 2007 年的 IABP 患者数据库；共有 311 例 CABG 患者接受了围手术期 IABP 治疗。在 311 例患者中，有 41 例高危患者首次接受了体外循环或非体外循环 CABG（存在以下三个或更多标准：左心室射血分数小于 0.45、不稳定型心绞痛、CABG 合并动脉瘤切除术或左主干狭窄大于 70%）。我们比较了术前接受 IABP 置入术的 20 例患者（组 1）和术中或术后接受强制性 IABP 置入术的 21 例患者（组 2）的围手术期临床结果。两组患者的术前危险因素无差异，除左心室动脉瘤切除术外。两组高危患者的适应证无差异。平均移植数量相似。术后需要使用正性肌力药物以及发生脑血管、胃肠道、肾脏和感染并发症的差异无统计学意义。两组均无 IABP 相关并发症。术中主要不良心脏事件（严重低血压和/或休克、心肌梗死和严重血流动力学不稳定）在组 2（14 [66.4%] vs. 1 [5%]，P < 0.0001）中更高。组 1 的 IABP 泵血时间短于组 2（72.5 +/- 28.9 h vs. 97.5 +/- 47.7 h，P < 0.05）。组 1 的通气时间和重症监护病房住院时间明显短于组 2，分别为（22.0 +/- 1.6 h vs. 39.6 +/- 2.1 h，P < 0.01 和 58.0 +/- 1.5 h vs. 98.5 +/- 1.9 h，P < 0.005）。两组死亡率无差异（组 1 死亡 1 例，组 2 死亡 3 例）。高危患者行 CABG 时可安全进行术前和预防性 IABP 置入，结果与术中及术后接受强制性 IABP 置入的患者相似。因此，作为手术策略一部分的早期 IABP 支持可能有助于改善高危首次 CABG 患者的预后。
