Heparin-free Management of Intra-aortic Balloon Pump after Cardiac Surgery

Kogan, Alexander; Preisman, Sergey; Sternik, Leonid; Orlov, Boris; Spiegelstein, Dan; Hod, Hanoch; Malachy, Ateret; Levin, Shany; Raanani, Ehud

doi:10.1111/j.1540-8191.2012.01484.x

Cited by 17 publications

(8 citation statements)

References 14 publications

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“…In addition, IABP catheterrelated local wound infections and systemic infections among the rare complications which should be kept in mind. [6,[8][9][10][11][12] In the literature, IABP complications are similar to those reported in our study population. Among the patients with IABP inserted in the OR, critical leg ischemia was observed in two patients and retroperitoneal hematoma due to vascular trauma in one patient.…”

Section: Discussionsupporting

confidence: 89%

In which conditions should we insert an intra-aortic balloon pump? In the operating room or intensive care unit?

İner¹

2020

Cardiovasc Surg Int

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In this study, we aimed to evaluate complications of intra-aortic balloon pump catheters inserted percutaneously in the operating room versus in the intensive care unit setting.Patients and methods: Between January 2013 and January 2016, a total of 71 patients (54 males, 17 females; mean age 63.0 years, range, 41 to 84 years) who underwent percutaneous intra-aortic balloon pump insertion in the operating room or in the intensive care unit were retrospectively reviewed. The patients were divided into two groups as Group 1 (n=48) consisting of the patients with intra-aortic balloon pump inserted in the operating room and Group 2 (n=23) consisting of those who underwent intra-aortic balloon pump in the intensive care unit. Both groups were compared in terms of pre-and post-procedural data and the effects of intra-aortic balloon pump insertion performed in the intensive care unit and operating room settings on reproductive pathology results of the catheters were assessed. Results:The mean pre-and post-procedural platelet counts were significantly higher in Group 2 than Group 1. After the procedure, the incidence of growth only was higher in the cultures collected from the tips of the catheters inserted in the intensive care unit. Conclusion:Insertion of intra-aortic balloon pump catheters in the operating room is more secure than the catheters inserted in the intensive care unit in terms of catheter infections. Therefore, in patients who are scheduled for intra-aortic balloon pump support in the intensive care unit setting, this procedure should be considered to be performed under operating room conditions, if the mobility of the patient is ensured.

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Section: Discussionsupporting

confidence: 89%

In which conditions should we insert an intra-aortic balloon pump? In the operating room or intensive care unit?

İner¹

2020

Cardiovasc Surg Int

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“…32 Frank et al 28 also documented the necessity of increased blood transfusion with the use of heparin for IABP insertion. Kogan et al 33 in his study demonstrated the reduced need for blood transfusion by minimizing the need for heparin in IABP insertion.…”

Section: Discussionmentioning

confidence: 97%

Factors determining blood transfusion in patients undergoing off pump coronary artery bypass graft (OPCABG) surgery: A prospective cross-sectional study

C¹,

Varma²,

Khadanga³

et al. 2021

IJCA

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Cardiovascular disease, especially coronary heart disease is increasing to a great extent globally and in India. Off pump Coronary artery bypass graft is one of the surgical modalities in the treatment of Coronary artery heart disease. Blood/ blood component transfusion is one of the essential roles during/immediate postoperative period of off pump coronary artery bypass graft surgery. Though there are few benefits due to blood transfusion, the demerits outweigh the merits of blood transfusion. Hence identification of predisposing factors for need of blood /blood component transfusions will enhance us to understand the indications and the ways to minimize it. To determine the predisposing factors that influence the need for blood transfusion during off pump coronary artery bypass graft and to measure their strength of association. This cross-sectional study was done in a tertiary care cardiac center in India between March and September 2016 on 196 patients. The participants were from both sexes, aged between 40-70 years, undergoing elective or emergency OPCABG under general anaesthesia. Information on Demographic data and comorbid illnesses were elicited. Vitals and other hemodynamic parameters were recorded during preoperative, intra operative and post operative periods. Total amount of anticoagulant (heparin) used, activated clotting time (ACT) after 3 minutes of anticoagulation, total duration of graft harvest (time from start of first graft harvesting to end of last graft harvest), total number of grafts taken, total duration for anastamoses (time from start of anastamosis to end of last graft anastamosis), total blood loss and total amount of blood transfused were noted. The intra-operative factors included total intra-operative heparin used, total protamine used, total number of grafts used for anastamoses, total duration of graft anastamoses, total duration of surgery, total duration of anaesthesia, total intra-operative blood loss and insertion of IABP intra-operatively. The post operative factors included total amount of postoperative blood loss and post operative insertion of IABP. Multivariate analysis of significant factors showed male gender, preoperative anaemia and total duration of surgery were independent predictors of need of blood and blood product transfusion. Prior identification of risk factors and correction of them if applicable would help to assess and manage preoperatively and also thereby reduce the need for blood transfusions and help in managing optimal utilization of resources.

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“…In a trial with 153 patients requiring IABP at a single center between 2001 and 2004, there was a higher incidence of bleeding in the heparinized (14.1 %) vs. non-heparinized (2.4 %) group, but there was no difference in the incidence of limb ischemia [ 26 ]. As a result, there are no clear recommendations for the use of heparin to prevent thrombosis and embolization with IABP; however, heparin is used with most patients [ 27 ]. Although industry guidelines do not require anticoagulation with IABP, especially at a 1:1 ratio, heparin use with IABP in patients without contraindications, maintained >24 h, and with a lower ratio (e.g., 1:2) is thought to be reasonable [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Intra-aortic balloon pump-assisted major hepatectomy in a case with coronary disease

et al. 2015

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Clinically, we often encounter cancer patients who also have cardiovascular disease such as coronary artery disease. We experienced a case of severe coronary artery disease and a large hepatocellular carcinoma in a 69-year-old man. To reduce the risk of a perioperative cardiovascular event during mesohepatectomy, an elective intra-aortic balloon pump (IABP) was used. After an uneventful recovery, the patient was discharged on day 15. While IABP is frequently introduced in cardiac surgery, there have been few reports of its use during liver surgery. Here, we present IABP-assisted major hepatectomy as an option in a patient with both cancer and coronary artery disease.

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Heparin-free Management of Intra-aortic Balloon Pump after Cardiac Surgery

Cited by 17 publications

References 14 publications

In which conditions should we insert an intra-aortic balloon pump? In the operating room or intensive care unit?

In which conditions should we insert an intra-aortic balloon pump? In the operating room or intensive care unit?

Factors determining blood transfusion in patients undergoing off pump coronary artery bypass graft (OPCABG) surgery: A prospective cross-sectional study

Intra-aortic balloon pump-assisted major hepatectomy in a case with coronary disease

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