Outcome analysis for prediction of early and long-term survival in patients receiving intra-aortic balloon pumping after cardiac surgery

Abstract

BackgroundPatients requiring an intra-aortic balloon pump (IABP) after cardiac surgery are critically ill and need a prolonged ICU stay. Considering limited health care resources, the early identification of patients with an extremely poor prognosis is important as a solid base for the decision whether further aggressive continuation or cessation of the therapy is recommendable.MethodsFrom 2001 to 2007, 552 patients with low-output syndrome after open-heart surgery and IABP implantation in OR or within 24 h thereafter on ICU were retrospectively analyzed.ResultsThe overall mortality at 30 and 180-day were 31 and 40 %, respectively. According to multivariate analyses, following factors were used to generate an IABP score: female gender, age ≥70 years, simultaneous coronary and valve surgery, aortic cross-clamp time >120 min., need of norepinephrin more than 0.4 µg kg−1 min−1, postoperative dialysis, and maximal serum creatinine kinase >3000 mg mL−1. The 30-day mortality continuously increased along the score (10.1 % for score = 0, n = 98; 11.8 % for score = 1, n = 144; 27.5 % for score = 2, n = 153; 40.4 % score = 3, n = 89; 65.2 % for score = 4, n = 46; 77.8 % for score = 5, n = 27) and reached 100 % for all patients with a score of 6 (n = 4).ConclusionsPrediction of 30 days mortality was possible with our scoring system based on multivariate analysis, and patients with scores of 4 or greater had remarkably worse early and late survival.

Outcomes after intra-aortic balloon pump insertion in cardiac surgery patients

“…These incidents are not surprising because the number of older patients is growing, and they have more coexisting diseases (such as chronic kidney injury, peripheral vascular disease and others), which affect outcomes of critically ill patients, particularly cardiac surgery patients (independent of the need for IABP-support). ( 12 , 13 ) More specifically, a study in 2016 with 522 patients found that age above 70 years was an independent risk factor for mortality within 30 days. ( 12 ) In addition, in 2015, another working group of 572 patients concluded that patients older than 65 years undergoing IABP support had higher in-hospital mortality rates in comparison to younger patients.…”

“…( 12 , 13 ) More specifically, a study in 2016 with 522 patients found that age above 70 years was an independent risk factor for mortality within 30 days. ( 12 ) In addition, in 2015, another working group of 572 patients concluded that patients older than 65 years undergoing IABP support had higher in-hospital mortality rates in comparison to younger patients. ( 14 ) In the same direction, two studies in 2015 and 2016 included advanced age as one of the most important predictors of in-hospital mortality and adverse long term prognosis.…”

“…Among those who had that type of surgery, 47.5% died within 30 days; among those who did not have such a procedure, the mortality rate was 26.3%. ( 12 ) In 2010, another study with 136 patients requiring an IABP concluded that the “operation-specific” mortality was higher in the heart valve surgery population. More specifically, the mortality rates were 21.2%, 50% and 64.3% among those who had isolated CABG, CABG and valve surgery and isolated valve surgery, respectively.…”

Levosimendan for patients with severely reduced left ventricular systolic function and/or low cardiac output syndrome undergoing cardiac surgery: a systematic review and meta-analysis

“…Older patients and those with a higher degree of comorbidities are currently referred for cardiac surgery [ 4 ], and, even if such patients may benefit from cardiac surgery, they are at increased risk for perioperative complications that result in high morbidity and mortality [ 5 ]. Patients with a severely depressed left ventricular ejection fraction (LVEF < 35%) are particularly at increased risk of developing postoperative low cardiac output syndrome (LCOS) [ 6 ], which in turn is associated with higher mortality [ 7 ].…”

Long-term outcomes of cabg with intra-aortic balloon pump support

“…Unlike the vast majority reference publications of in-hospital (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)) and short-term (2-6 months) outcomes of CABG with IABP support (17,18), the long-term outcomes (mainly up to 15 years) are limited to as few as 9 series, which are mostly presented by analysis of the either long-term survival, or mortality. The analysis was conducted without differentiation between isolated and combined CABG with correction of MI (myocardial infarction) mechanical complications/valvular prosthesis; elective/urgent surgery (18)(19)(20)(21)(22)(23). The long-term outcomes in isolated on-pump/off-pump CABG were analyzed in three series (1,4,20); the outcomes of isolated and combined CABG -in 6 series (6,7,10,11,18,19).…”