Effect of a Perioperative Intra-Aortic Balloon Pump in High-Risk Cardiac Surgery Patients: A Randomized Clinical Trial

Ferreira, Gerson Moura; Almeida, Juliano Pinheiro de; Landoni, Giovanni; Vincent, Jean‐Louis; Fominskiy, Evgeny; Galas, Filomena Regina Barbosa Gomes; Gaiotto, Fábio Antônio; Dallan, Luís Alberto de Oliveira; Franco, Rafael Alves; Lisboa, Luiz Augusto Ferreira; Dallan, Luís Roberto Palma; Fukushima, Júlia Tizue; Rizk, Stéphanie Itala; Park, Clarice Lee; Strabelli, Tânia Mara Varejão; Lage, Silvia G.; Câmara, Lígia; Jardim, Jaquelline Maria; Arita, Elisandra Cristina Trevisan Calvo; Caldas, Juliana; Ayub‐Ferreira, Silvia Moreira; Auler, José Otávio Costa; Filho, Roberto Kalil; Jatene, Fábio Biscegli; Hajjar, Ludhmila Abrahão

doi:10.1097/ccm.0000000000003185

Cited by 27 publications

(27 citation statements)

References 22 publications

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“…Regarding secondary endpoints, our study showed a significant difference favoring the IABP regarding requirement of renal replacement therapy and a lower risk of severe acute kidney injury, which are consistent with previous reports [9][10][11]17]. Likewise, a significantly longer stay in the ICU was observed in the patients of the IABP group, contrary to the results reported in previous registries [3,18,19].…”

Section: Discussionsupporting

confidence: 89%

“…For example, a reduced mortality risk, postoperative AMI, and renal failure had been previously described in small-sized RCTs and a meta-analysis [1][2][3][4][5]11]. However, other RCTs have shown no difference in 30-day mortality or morbidity associated with the perioperative use of IABP, whereas more recent studies have argued that the hemodynamic effects of the IABP are modest and do not result in a significant increase in cardiac output, left ventricular stroke work index, or systemic vascular resistance [6][7][8][9][10]. Consistently, in our study, preoperative use of IABP did not significantly reduce 30day mortality in the all-population analysis, but in the LVEF > 35% subanalysis, which may partially explain previous controversial results.…”

Section: Discussionmentioning

confidence: 99%

“…The intra-aortic balloon pump (IABP) is widely used to improve coronary perfusion and prevent complications [5][6][7]. Some recent randomized controlled trials (RCTs) have suggested that IABP insertion does not improve the ventricular function and does not reduce complications in patients with cardiogenic shock after acute myocardial infarction (AMI) [8]; preoperative IABP use may prevent complications in high-risk patients undergoing CABG [9][10][11][12]. A recent meta-analysis suggested that preoperative IABP use is associated with mortality reduction [11], but these findings were mainly derived from small RCTs.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative Use of Intra-Aortic Balloon Pump Support Reduced 30-Day Mortality in a Population with LVEF >35% and High Surgical Risk after Coronary Artery Bypass Graft Surgery

Escutia-Cuevas¹,

Suárez‐Cuenca²,

Espinoza-Rueda³

et al. 2020

Cardiology

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Introduction: The intra-aortic balloon pump (IABP) is used to prevent complications after coronary artery bypass grafting (CABG) surgery, although some results are controversial and basal ventricular function may play a role. This study assessed the benefit of preoperative use of IABP, as stratified by the ventricular function, in a population submitted to high-surgical-risk CABG. Methods: Patients > 18 years old, with multiple coronary artery disease and thus candidates for CABG, were included. Cardiogenic shock, acute myocardial infarction (AMI), acute ventricle mechanical dysfunction, severe aortic regurgitation, tachyarrhythmia, massive pulmonary embolism, coagulopathy, or low life expectancy Escutia-Cuevas et al.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preoperative Use of Intra-Aortic Balloon Pump Support Reduced 30-Day Mortality in a Population with LVEF >35% and High Surgical Risk after Coronary Artery Bypass Graft Surgery

Escutia-Cuevas¹,

Suárez‐Cuenca²,

Espinoza-Rueda³

et al. 2020

Cardiology

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“…Two further recent studies-one an RCT-have also demonstrated no difference between clinical endpoints in patients receiving IABP therapy prophylactically. In fact, they demonstrate increased ITU length of stay and duration of inotrope use in the IABP groups [20,21].…”

Section: Clinical Outcomesmentioning

confidence: 91%

Mechanical support for high-risk coronary artery bypass grafting

Ali

Abu‐Omar

2018

Indian J Thorac Cardiovasc Surg

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Mechanical circulatory support devices are being used to an increasing extent. The use of these devices as an adjunct to cardiac surgery to support ventricular function has contributed to improved outcomes for the highest risk patients. In the context of patients undergoing coronary artery bypass grafting, there are several potential indications for mechanical circulatory support: preoperatively in the setting of acute cardiogenic shock, or in patients with intractable angina with or without haemodynamic compromise; at induction of anaesthesia prophylactically in patients with critical coronary anatomy and/or severely impaired left ventricular function; intraoperatively in the setting of failure to wean from cardiopulmonary bypass; or postoperatively in patients who develop an intractable low cardiac output state. The use of the intra-aortic balloon pump, veno-arterial extracorporeal membrane oxygenation, TandemHeart, Impella and central ventricular assist devices will be considered in the setting of high-risk patients undergoing coronary artery bypass grafting.

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“…For more than 30 years it has been used for critically ill cardiac patients. The effectiveness of intra-aortic balloon pump in the preoperative period for high-risk coronary artery bypass grafting patients was suggested in literature (2). Positive preoperative benefits of this technology may yield good outcomes due to its hemodynamic effect, minimize the length of intensive care unit and the hospital stay and decrease the complications.…”

Section: Introductionmentioning

confidence: 99%

Outcomes With Intra-Aortic Balloon Pump in High Risk Cardiac Surgery Patients

Moursi¹,

Fakharany²

2018

Zagazig University Medical Journal

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Introduction:In high-risk cardiac surgical patients the intra-aortic balloon pump (IABP) is the most frequent used tool for temporary mechanical circulatory support during the perioperative phase. The effects of IABP are an increase in diastolic blood pressure, an improvement in coronary perfusion and a reduction of ventricular afterload, so it increases the stroke volume and cardiac output. Objective:To study the effect of preoperative use of intra-aortic balloon pump (IABP) on the outcome of high-risk patients that were subjected to coronary artery bypass graft (CABG) surgery. Methods: From June 2009 to June 2011. Group of 100 patients considered as high-risk patients were subjected to elective bypass cardiac surgery at our center. Forty patients subjected to preoperative IABP as a prophylactic measure and 60 patients were not subjected to IABP. This is retrospective study of prospectively collected data .The definition of High risk was the presence of two or more known risk factors. The patient's outcome is compared regarding the predicted mortality of the Euro SCORE. The preoperative effect of IABP on the outcome, mortality and 30 days follow-up was statistically analyzed. Results:Forty patients subjected to preoperative IABP as prophylactic measure due to higher Euro SCORE-predicted mortality than other 60 patients did not subject to IABP(60% vs 40 %, P = ˂0.05). Seventy patients (70%) were male while (30%) were female with a mean age of 58.62 ± 9.65 years. Patients subjected to preoperative IABP had increased a percentage of hospital mortality (P = ˂0.05) but this percentage is relatively lower than predicted by Euro SCORE. Patients subjected to preoperative IABP had lower rate of postoperative complication (acute kidney insult (P = 0.045), cardiac surgical intensive care unit (CSICU) stay (P = 0.032) and decrease the need for postoperative inotrope (P = 0.046)) compared to patients without preoperative IABP use. Other complications postoperative were low and similar in both groups. Conclusions: We conclude that patients have high-risk CABG, the preoperative IABP in this group with higher predicted mortality was associated with a relative reduction than predicted by Euro score. The preoperative IABP in this group has a reliable and acceptable outcome on postoperative complications.

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Effect of a Perioperative Intra-Aortic Balloon Pump in High-Risk Cardiac Surgery Patients: A Randomized Clinical Trial

Abstract: In high-risk patients undergoing cardiac surgery, the perioperative use of an intra-aortic balloon pump did not reduce the occurrence of a composite outcome of 30-day mortality and major complications compared with usual care alone.

Cited by 27 publications

References 22 publications

Preoperative Use of Intra-Aortic Balloon Pump Support Reduced 30-Day Mortality in a Population with LVEF >35% and High Surgical Risk after Coronary Artery Bypass Graft Surgery

Preoperative Use of Intra-Aortic Balloon Pump Support Reduced 30-Day Mortality in a Population with LVEF >35% and High Surgical Risk after Coronary Artery Bypass Graft Surgery

Mechanical support for high-risk coronary artery bypass grafting

Outcomes With Intra-Aortic Balloon Pump in High Risk Cardiac Surgery Patients

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Effect of a Perioperative Intra-Aortic Balloon Pump in High-Risk Cardiac Surgery Patients: A Randomized Clinical Trial

Abstract: In high-risk patients undergoing cardiac surgery, the perioperative use of an intra-aortic balloon pump did not reduce the occurrence of a composite outcome of 30-day mortality and major complications compared with usual care alone.

Cited by 27 publications

References 22 publications

Preoperative Use of Intra-Aortic Balloon Pump Support Reduced 30-Day Mortality in a Population with LVEF &#x3e;35% and High Surgical Risk after Coronary Artery Bypass Graft Surgery

Preoperative Use of Intra-Aortic Balloon Pump Support Reduced 30-Day Mortality in a Population with LVEF &#x3e;35% and High Surgical Risk after Coronary Artery Bypass Graft Surgery

Mechanical support for high-risk coronary artery bypass grafting

Outcomes With Intra-Aortic Balloon Pump in High Risk Cardiac Surgery Patients

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Product

Resources

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Preoperative Use of Intra-Aortic Balloon Pump Support Reduced 30-Day Mortality in a Population with LVEF >35% and High Surgical Risk after Coronary Artery Bypass Graft Surgery

Preoperative Use of Intra-Aortic Balloon Pump Support Reduced 30-Day Mortality in a Population with LVEF >35% and High Surgical Risk after Coronary Artery Bypass Graft Surgery