Department of Cardiovascular Surgery, General Hospital of People's Liberation Army, Beijing 100853, China.
Chin Med J (Engl). 2019 Apr 20;132(8):935-942. doi: 10.1097/CM9.0000000000000178.
There are few reports of peri-operative application of intra-aortic balloon pumping (IABP) in patients with coronary artery disease (CAD) and different grades of left ventricular dysfunction. This study aimed to analyze the early outcomes of peri-operative application of IABP in coronary artery bypass grafting (CABG) among patients with CAD and left ventricular dysfunction, and to provide a clinical basis for the peri-operative use of IABP.
A retrospective analysis of 612 patients who received CABG in the General Hospital of People's Liberation Army between May 1995 and June 2014. Patients were assigned to an IABP or non-IABP group according to their treatments. Logistic regression analysis was performed to investigate the influence of peri-operative IABP implantation on in-hospital mortality. Further subgroup analysis was performed on patients with severe (ejection fraction [EF] ≤ 35%) and mild (EF = 36%-50%) left ventricular dysfunction.
Out of 612 included subjects, 78 belonged to the IABP group (12.7%) and 534 to the non-IABP group. Pre-operative left ventricular EF (LVEF) and EuroSCOREII predicted mortality was higher in the IABP group compared with the non-IABP group (P < 0.001 in both cases), yet the two did not differ significantly in terms of post-operative in-hospital mortality (P = 0.833). Regression analysis showed that IABP implantation, recent myocardial infarction, critical status, non-elective operation, and post-operative ventricular fibrillation were risk factors affecting in-hospital mortality (P < 0.01 in all cases). Peri-operative IABP implantation was a protective factor against in-hospital mortality (P = 0.0010). In both the severe and mild left ventricular dysfunction subgroups, peri-operative IABP implantation also exerted a protective role against mortality (P = 0.0303 and P = 0.0101, respectively).
Peri-operative IABP implantation could reduce the in-hospital mortality and improve the surgical outcomes of patients with CAD with both severe and mild left ventricular dysfunction.
有少数关于主动脉内球囊反搏（IABP）在冠状动脉疾病（CAD）和不同程度左心功能不全患者围手术期应用的报告。本研究旨在分析 CAD 合并左心功能不全患者冠状动脉旁路移植术（CABG）围手术期应用 IABP 的早期结果，并为 IABP 围手术期应用提供临床依据。
回顾性分析 1995 年 5 月至 2014 年 6 月在解放军总医院接受 CABG 的 612 例患者。根据治疗方法将患者分为 IABP 组和非 IABP 组。采用 logistic 回归分析探讨围手术期 IABP 植入对住院死亡率的影响。对左心室射血分数（LVEF）严重（EF≤35%）和轻度（EF=36%-50%）左心功能不全患者进行亚组分析。
612 例入选患者中，IABP 组 78 例（12.7%），非 IABP 组 534 例。IABP 组患者术前左心室射血分数（LVEF）和欧洲心脏手术风险评分 II（EuroSCOREII）预测死亡率高于非 IABP 组（P均<0.001），但两组患者术后住院死亡率差异无统计学意义（P=0.833）。回归分析显示，IABP 植入、近期心肌梗死、危急状态、非择期手术和术后室颤是影响住院死亡率的危险因素（P均<0.01）。围手术期 IABP 植入是降低住院死亡率的保护因素（P=0.0010）。在左心室射血分数严重和轻度两组亚组中，围手术期 IABP 植入对死亡率也有保护作用（P=0.0303 和 P=0.0101）。
围手术期 IABP 植入可降低 CAD 合并严重和轻度左心功能不全患者的住院死亡率，改善手术结局。
