Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, Netherlands.
Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands.
Interact Cardiovasc Thorac Surg. 2022 Jun 15;35(1). doi: 10.1093/icvts/ivac091.
Although the intra-aortic balloon pump (IABP) has been the most widely adopted temporary mechanical support device in cardiac surgical patients, its use has declined. The current study aimed to evaluate the occurrence and predictors of early mortality and complication rates in contemporary cardiac surgery patients supported by an IABP.
A multicentre, retrospective analysis was performed of all consecutive cardiac surgical patients receiving perioperative balloon pump support in 8 centres between January 2010 to December 2019. The primary outcome was early mortality, and secondary outcomes were balloon-associated complications. A multivariable binary logistic regression model was applied to evaluate predictors of the primary outcome.
The study cohort consisted of 2615 consecutive patients. The median age was 68 years [25th percentile 61, 75th percentile 75 years], with the majority being male (76.9%), and a mean calculated 30-day mortality risk of 10.0%. Early mortality was 12.7% (n = 333), due to cardiac causes (n = 266), neurological causes (=22), balloon-related causes (n = 5) and other causes (n = 40). A composite end point of all vascular complications occurred in 7.2% of patients, and leg ischaemia was observed in 1.3% of patients. The most important predictors of early mortality were peripheral vascular disease [odds ratio (OR) 1.63], postoperative dialysis requirement (OR 10.40) and vascular complications (OR 2.57).
The use of the perioperative IABP proved to be safe and demonstrated relatively low complication rates, particularly for leg ischaemia. As such, we believe that specialists should not be held back to use this widely available treatment in high-risk cardiac surgical patients when indicated.
主动脉内球囊反搏（IABP）是心脏外科患者最广泛采用的临时机械支持装置，但它的使用有所减少。本研究旨在评估当前接受 IABP 支持的心脏外科患者的早期死亡率和并发症发生率的发生情况及其预测因素。
对 2010 年 1 月至 2019 年 12 月 8 家中心接受围术期球囊泵支持的所有连续心脏外科患者进行了多中心回顾性分析。主要结局是早期死亡率，次要结局是与球囊相关的并发症。应用多变量二项逻辑回归模型评估主要结局的预测因素。
研究队列包括 2615 例连续患者。中位年龄为 68 岁[25%分位数为 61 岁，75%分位数为 75 岁]，大多数为男性（76.9%），平均计算的 30 天死亡率风险为 10.0%。早期死亡率为 12.7%（n=333），死亡原因分别为心脏原因（n=266）、神经原因（n=22）、球囊相关原因（n=5）和其他原因（n=40）。所有血管并发症的复合终点发生在 7.2%的患者中，1.3%的患者出现腿部缺血。早期死亡率的最重要预测因素是外周血管疾病[比值比（OR）1.63]、术后透析需求（OR 10.40）和血管并发症（OR 2.57）。
围术期 IABP 的使用被证明是安全的，且并发症发生率相对较低，特别是腿部缺血。因此，我们认为，在有指征的情况下，高危心脏外科患者应毫不犹豫地使用这种广泛可用的治疗方法。
