Coronary artery bypass grafting in patients with low ejection fraction: The effect of intra-aortic balloon pump insertion on early outcome

Davoodi, Saeed; Karimi, Abbasali; Ahmadi, Seyed Hossein; Marzban, Mehrab; Movahhedi, Namvar; Abbasi, Kyomars; Omran, Abbas Salehi; Shirzad, Mahmood; Sheikhvatan, Mehrdad; Abbasi, Seyed Hesameddin

doi:10.4103/0019-5359.42482

Cited by 14 publications

(7 citation statements)

References 30 publications

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“…The amount of the postoperative blood loss can differ significantly between studies due to several factors related to the patients, surgical technique and surgeons. Mechanical ventilation, ICU and hospital were significantly longer in low EF patients which is consistent with what is reported in the literature [12]. Low EF is associated with hemodynamic instability, the increased use of IABP and inotropes and these factors affect the duration of mechanical, ICU and hospital stay directly.…”

Section: Discussionsupporting

confidence: 90%

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Early Outcomes of Coronary Artery Bypass Grafting in Patients with Low Ejection Fraction

Aljunaidy

Husseen

Ali

et al. 2019

Egypt. Cardiothoracic. Surg.

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Background: Patients with low ejection fraction (EF) are at a higher risk for postoperative complications and mortality. Our objective was to assess the effect of low EF (<40%) on early clinical outcomes after coronary artery bypass grafting (CABG) and to determine the predictors of mortality. Methods: From June 2017 to February 2019, 170 consecutive patients underwent CABG. There were 120 patients with low EF (<40%; 37.49 ± 2.89%); 94 were men (78.3%), and the mean age was 55.83 ± 8.04 years. Fifty patients had normal EF (> 40; 57.90 ± 2.27 %), 41 were men (82.0%), and the mean age was 54.30 ± 7.01 years and used as a control group. Results: Overall 30-day mortality was 10/120 patients (8.3%). Factors associated with higher mortality were females ( 70.0% vs. 17.3%, P<0.001); older age (61.40 ± 7.01 vs. 55.32 ± 7.97 years, P=0.025); diabetes mellitus (100% vs. 51.8%; P=0.003); longer cardiopulmonary bypass time (148.70 ± 40.12 vs. 108.49 ± 36.89 min; P=0.012); longer cross clamp time (88.19 ± 31.94 vs.64.77 ± 22.67 min; P=0.049), longer total operative time (6.82 ± 1.03 vs 5.38 ± 0.95 hours; P=0.001); intra-aortic balloon pump (IABP) insertion (90.0% vs. 10.9%; P<0.001); intra-operative complications (60% vs. 1.8%, P<0.001); ventricular tachycardia and ventricular fibrillation (30% and 50% vs. 4.5% and 5.5% respectively; P=0.002 for both); myocardial infarction (70% vs 11.8%, P<0.001), and lower postoperative ejection fraction (21.46 ± 1.93 vs 40.30 ± 8.19 %, P<0.001). In patients with low EF, postoperative NYHA and CCS angina class have improved compared to the preoperative levels (1.50 ± 0.61 vs. 3.31 ± 0.56; p< 0.001 and 1.38 ± 0.52 vs. 3.11 ± 0.55; p< 0.001 respectively) Conclusion: Patients with low EF have a higher risk of morbidity and mortality; however, the clinical and echocardiographic parameters improve over time. Therefore, CABG remains a viable option in selected patients with low EF. Factors affecting our 30-days mortality were related to the severity of the disease. Article History https://doi.org/10.35810/ects.v1i2.43 BMI= body mass index, EF= ejection fraction, LVEDD = left ventricular end diastolic diameter, LVESD= left ventricular end systolic diameter, CPB= cardiopulmonary bypass, ACC= aortic cross clamp, DC= defibrillating cardiac ICU= intensive care unit, IABP= intra-aortic balloon pump, NYHA= New York Heart Association, EF= ejection fraction, LVEDD = left ventricular end diastolic diameter, LVESD= left ventricular end systolic diameter, AF= atrial fibrillation, V Tach= Ventricular tachycardia, VF= ventricular fibrillation. Aljunaidy L.

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Section: Discussionsupporting

confidence: 90%

“…Low EF is associated with hemodynamic instability, the increased use of IABP and inotropes and these factors affect the duration of mechanical, ICU and hospital stay directly. Postoperative complications were independently related to low EF including infectious and neurological complications [8,12].…”

Section: Discussionmentioning

confidence: 99%

Early Outcomes of Coronary Artery Bypass Grafting in Patients with Low Ejection Fraction

Aljunaidy

Husseen

Ali

et al. 2019

Egypt. Cardiothoracic. Surg.

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“…Reduced survival in patients with a high risk of complications and anticipated long ICU stays should be considered when discussing surgical versus nonsurgical options.Factors associated with length of stay (LOS) in the intensive care unit (ICU) following cardiac surgery are well described. These include demographic variables such as age and gender, 1-5 preoperative comorbidities such as myocardial infarction (MI) and heart failure, 3,4,6,7 and operative factors such as cardiopulmonary bypass (CPB) time and emergent status. 5,8 Postoperative complications, such as stroke, MI, and deep sternal wound infection (DSWI), have also been associated with prolonged intensive care duration.…”

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confidence: 99%

What Happens After Discharge? An Analysis of Long-Term Survival in Cardiac Surgical Patients Requiring Prolonged Intensive Care

Elfström

Hatefi

Kilgo

et al. 2011

Journal of Cardiac Surgery

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“…These factors reß ect the severity of underlying cardiac dysfunction. Davoodi et al [11] have interesting observations. In their study involving over eight hundred high-risk cases the use of IABP was associated with prolonged hospital stay and independently predicted mortality at 1 month.…”

Section: Usage Of Intra-aortic Balloon Pump In High Risk Coronary Artmentioning

confidence: 94%

Usage of intra-aortic balloon pump in high risk coronary artery bypass graft surgery

Shankar

2008

Indian J Med Sci

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Coronary artery bypass grafting in patients with low ejection fraction: The effect of intra-aortic balloon pump insertion on early outcome

Abstract: BACKGROUND: Survival benefit with intra-aortic balloon pump (IABP) insertion for coronary artery bypass grafting (CABG) patients with left ventricular dysfunction is

Cited by 14 publications

References 30 publications

Early Outcomes of Coronary Artery Bypass Grafting in Patients with Low Ejection Fraction

Early Outcomes of Coronary Artery Bypass Grafting in Patients with Low Ejection Fraction

What Happens After Discharge? An Analysis of Long-Term Survival in Cardiac Surgical Patients Requiring Prolonged Intensive Care

Usage of intra-aortic balloon pump in high risk coronary artery bypass graft surgery

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