Aga Khan University Hospital, Karachi, Pakistan.
Perfusion. 2024 Oct;39(7):1396-1404. doi: 10.1177/02676591231193977. Epub 2023 Aug 3.
Intra-aortic balloon pump (IABP) insertion for diminished myocardial function is standard of care in cardiac surgery. Previous studies have suggested a possible benefit to IABP support before surgery with regards to outcomes and complications. However, there are conflicts with other studies suggesting no significant benefit. Optimal time of insertion, whether preoperative or perioperative (intra-operative and post-operative), has yet to be defined.
A retrospective, hospital records-based chart review was conducted for patients admitted to our center from January 2015 to December 2019 for coronary bypass surgery necessitating IABP insertion. Cases were stratified according to the timing of insertion and analyzed according to surgical outcomes and complication rates.
Out of 97 patients, 84.5% underwent preoperative IABP insertion while 15.5% of patients received perioperative (Intra-operative or post-operative) insertion. In-hospital mortality was significantly higher in patients with perioperative IABP insertion as compared to the preoperative group (60% vs 20.7%, = 0.003). However, there were no significant differences between 30-day readmission rates in the two groups (9.8% vs 6.7%, = 1.000). Length of stay was also higher in patients with preoperative insertion of IABP ( = 0.032), with no significant difference in ICU stay ( = 0.107). Perioperative IABP patients had higher rates of arrhythmias (46.7%, = 0.042) and reopening of patient (33.3%, = 0.028).
Our study shows improved mortality in patients with preoperatively inserted IABP. This may be beneficial for high-risk patients undergoing CABG surgery. Expanding the use of IABP before CABG in third world countries such as Pakistan may improve overall survival for patients.
主动脉内球囊泵（IABP）用于心肌功能减退的患者，在心脏手术中是标准的治疗方法。先前的研究表明，在手术前使用 IABP 支持可能对预后和并发症有一定的益处。然而，也有其他研究表明其益处并不显著，存在争议。最佳的插入时间，无论是术前还是围手术期（术中及术后），尚未确定。
对 2015 年 1 月至 2019 年 12 月期间因需要 IABP 插入而在我们中心接受冠状动脉旁路手术的患者进行回顾性病历回顾。根据插入时间将病例分层，并根据手术结果和并发症发生率进行分析。
在 97 例患者中，84.5%的患者进行了术前 IABP 插入，而 15.5%的患者接受了围手术期（术中或术后）插入。与术前组相比，围手术期 IABP 插入的患者住院死亡率显著更高（60%比 20.7%， = 0.003）。然而，两组 30 天再入院率无显著差异（9.8%比 6.7%， = 1.000）。IABP 术前插入的患者住院时间更长（ = 0.032），而 ICU 住院时间无显著差异（ = 0.107）。围手术期 IABP 患者心律失常发生率更高（46.7%， = 0.042），再次开胸率更高（33.3%， = 0.028）。
我们的研究表明，术前插入 IABP 的患者死亡率降低。对于接受 CABG 手术的高危患者，这可能是有益的。在巴基斯坦等第三世界国家扩大 IABP 在 CABG 前的应用，可能会提高患者的总体生存率。
