Effect of preoperative intra-aortic balloon pump insertion in patients undergoing off-pump coronary artery bypass grafting: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 FANG Lei , WANG Pishan , JIN Qilin , WANG Po , MENG Xiangkuan

Department of Cardiac Surgery, Capital Medical University Daxing Teaching Hospital, Beijing, 102600, P.R.China;

Corresponding author：

FANG Lei, Email: Fanglei868@163.com

Keywords：

Off-pump coronary artery bypass grafting; intra-aortic balloon pump; preoperative insertion; clinical effect

DOI：

10.7507/1007-4848.202007059

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Objective To evaluate the clinical efficacy of preoperative intra-aortic balloon pump (IABP) insertion in patients with off-pump coronary artery bypass grafting (OPCABG) surgery.Methods The clinical data of 130 patients who underwent OPCABG with IABP from 2015 to 2019 in our hospital were retrospectively analyzed. The patients were divided into two groups, including a group A (preoperative IABP insertion, n=72) and a group B (emergent IABP insertion, n=58). There were 42 males and 30 females in the group A with an average age of 60-72 (65.0±5.2) years. There were 32 males and 26 females in the group B with an average age of 56-73 (62.3±7.6) years. The in-hospital mortality rate and prognosis were compared between the two groups.Results The in-hospital mortality rate in the group A (4.2%) was significantly lower than that in the group B (12.1%, P=0.002). The IABP time (40.8±10.3 min vs. 65.3±15.6 min), mechanical ventilation time (18.7±6.1 min vs. 48.7±10.5 min) and ICU stay time (48.1±7.8 min vs. 90.2±21.3 min) of the group A were shorter than those of the group B (P<0.05). The number of bypass grafts was not significantly different between the two groups (3.6±1.2 vs. 3.8±1.0, P=0.387). Multivariable logistic regression analysis indicated that independent risk factors for in-hospital mortality included age [OR=1.04, 95%CI (1.01, 1.10), P=0.030], female [OR=2.56, 95%CI (1.53, 6.12), P=0.000] and left ventricular end-diastolic diameter [OR=1.05, 95%CI (1.01, 1.13), P=0.030]. Preoperative IABP support was the protective factor [OR=0.17, 95%CI (0.01, 0.78), P=0.005].Conclusion Patients undergoing OPCABG with preoperative IABP insertion may reduce in-hospital mortality rate and improve outcomes.

Citation： FANG Lei, WANG Pishan, JIN Qilin, WANG Po, MENG Xiangkuan. Effect of preoperative intra-aortic balloon pump insertion in patients undergoing off-pump coronary artery bypass grafting: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(10): 1229-1233. doi: 10.7507/1007-4848.202007059 Copy

1.	Lamy A, Tong W, Devereaux PJ, et al. The cost implications of off-pump versus on-pump coronary artery bypass graft surgery at one year. Ann Thorac Surg, 2014, 98(5): 1620-1625.
2.	Dalén M, Ivert T, Holzmann MJ, et al. Long-term survival after off-pump coronary artery bypass surgery: A Swedish nationwide cohort study. Ann Thorac Surg, 2013, 96(6): 2054-2060.
3.	Wu C, Camacho FT, Zhao S, et al. Long-term mortality of coronary artery bypass graft surgery and stenting with drug-eluting stents. Ann Thorac Surg, 2013, 95(4): 1297-1305.
4.	Christenson JT, Badel P, Simonet F, et al. Preoperative intraaortic balloon pump enhances cardiac performance and improves the outcome of redo CABG. Ann Thorac Surg, 1997, 64(5): 1237-1244.
5.	Chaudhry UA, Harling L, Rao C, et al. Off-pump versus on-pump coronary revascularization: Meta-analysis of mid- and long-term outcomes. Ann Thorac Surg, 2014, 98(2): 563-572.
6.	McNeely C, Markwell S, Vassileva C. Trends in patient characteristics and outcomes of coronary artery bypass grafting in the 2000 to 2012 medicare population. Ann Thorac Surg, 2016, 102(1): 132-138.
7.	Lisboa LA, Mejia OA, Dallan LA. Which patients will benefit more from off-pump coronary artery bypass grafting? J Thorac Cardiovasc Surg, 2014, 147(1): 540-541.
8.	Field ML, Rengarajan A, Khan O, et al. Preoperative intra aortic balloon pumps in patients undergoing coronary artery bypass grafting. Cochrane Database Syst Rev, 2007, 1: CD004472.
9.	Qiu Z, Chen X, Xu M, et al. Evaluation of preoperative intra-aortic balloon pump in coronary patients with severe left ventricular dysfunction undergoing OPCAB surgery: Early and mid-term outcomes. J Cardiothorac Surg, 2009, 4: 39.
10.	Sá MP, Ferraz PE, Escobar RR, et al. Prophylactic intra-aortic balloon pump in high-risk patients undergoing coronary artery bypass surgery: A meta-analysis of randomized controlled trials. Coron Artery Dis, 2012, 23(7): 480-486.
11.	Matsushita T, Masuda S, Kanzaki T. A safe technique for using an enclose Ⅱ anastomosis assist device during off-pump coronary bypass. Ann Thorac Surg, 2016, 102(6): e581-e582.
12.	Mannacio V, Di Tommaso L, De Amicis V, et al. Preoperative intraaortic balloon pump for off-pump coronary arterial revascularization. Ann Thorac Surg, 2012, 93(3): 804-809.
13.	Dyub AM, Whitlock RP, Abouzahr LL, et al. Preoperative intra-aortic balloon pump in patients undergoing coronary bypass surgery: A systematic review and meta-analysis. J Card Surg, 2008, 23(1): 79-86.
14.	Diez C, Silber RE, Wächner M, et al. EuroSCORE directed intraaortic balloon pump placement in high-risk patients undergoing cardiac surgery--retrospective analysis of 267 patients. Interact Cardiovasc Thorac Surg, 2008, 7(3): 389-395.
15.	Shi M, Huang J, Pang L, et al. Preoperative insertion of an intra-aortic balloon pump improved the prognosis of high-risk patients undergoing off-pump coronary artery bypass grafting. J Int Med Res, 2011, 39(4): 1163-1168.
16.	Pilarczyk K, Boening A, Jakob H, et al. Preoperative intra-aortic counterpulsation in high-risk patients undergoing cardiac surgery: A meta-analysis of randomized controlled trials. Eur J Cardiothorac Surg, 2016, 49(1): 5-17.
17.	Deppe AC, Weber C, Liakopoulos OJ, et al. Preoperative intra-aortic balloon pump use in high-risk patients prior to coronary artery bypass graft surgery decreases the risk for morbidity and mortality--A meta-analysis of 9, 212 patients. J Card Surg, 2017, 32(3): 177-185.
18.	Poirier Y, Voisine P, Plourde G, et al. Efficacy and safety of preoperative intra-aortic balloon pump use in patients undergoing cardiac surgery: A systematic review and meta-analysis. Int J Cardiol, 2016, 207: 67-79.
19.	Theologou T, Bashir M, Rengarajan A, et al. Preoperative intra aortic balloon pumps in patients undergoing coronary artery bypass grafting. Cochrane Database Syst Rev, 2011, 1: CD004472.
20.	Bahekar A, Singh M, Singh S, et al. Cardiovascular outcomes using intra-aortic balloon pump in high-risk acute myocardial infarction with or without cardiogenic shock: A meta-analysis. J Cardiovasc Pharmacol Ther, 2012, 17(1): 44-56.
21.	Ding W, Ji Q, Wei Q, et al. Prophylactic application of an intra-aortic balloon pump in high-risk patients undergoing off-pump coronary artery bypass grafting. Cardiology, 2015, 131(2): 109-115.

1. Lamy A, Tong W, Devereaux PJ, et al. The cost implications of off-pump versus on-pump coronary artery bypass graft surgery at one year. Ann Thorac Surg, 2014, 98(5): 1620-1625.
2. Dalén M, Ivert T, Holzmann MJ, et al. Long-term survival after off-pump coronary artery bypass surgery: A Swedish nationwide cohort study. Ann Thorac Surg, 2013, 96(6): 2054-2060.
3. Wu C, Camacho FT, Zhao S, et al. Long-term mortality of coronary artery bypass graft surgery and stenting with drug-eluting stents. Ann Thorac Surg, 2013, 95(4): 1297-1305.
4. Christenson JT, Badel P, Simonet F, et al. Preoperative intraaortic balloon pump enhances cardiac performance and improves the outcome of redo CABG. Ann Thorac Surg, 1997, 64(5): 1237-1244.
5. Chaudhry UA, Harling L, Rao C, et al. Off-pump versus on-pump coronary revascularization: Meta-analysis of mid- and long-term outcomes. Ann Thorac Surg, 2014, 98(2): 563-572.
6. McNeely C, Markwell S, Vassileva C. Trends in patient characteristics and outcomes of coronary artery bypass grafting in the 2000 to 2012 medicare population. Ann Thorac Surg, 2016, 102(1): 132-138.
7. Lisboa LA, Mejia OA, Dallan LA. Which patients will benefit more from off-pump coronary artery bypass grafting? J Thorac Cardiovasc Surg, 2014, 147(1): 540-541.
8. Field ML, Rengarajan A, Khan O, et al. Preoperative intra aortic balloon pumps in patients undergoing coronary artery bypass grafting. Cochrane Database Syst Rev, 2007, 1: CD004472.
9. Qiu Z, Chen X, Xu M, et al. Evaluation of preoperative intra-aortic balloon pump in coronary patients with severe left ventricular dysfunction undergoing OPCAB surgery: Early and mid-term outcomes. J Cardiothorac Surg, 2009, 4: 39.
10. Sá MP, Ferraz PE, Escobar RR, et al. Prophylactic intra-aortic balloon pump in high-risk patients undergoing coronary artery bypass surgery: A meta-analysis of randomized controlled trials. Coron Artery Dis, 2012, 23(7): 480-486.
11. Matsushita T, Masuda S, Kanzaki T. A safe technique for using an enclose Ⅱ anastomosis assist device during off-pump coronary bypass. Ann Thorac Surg, 2016, 102(6): e581-e582.
12. Mannacio V, Di Tommaso L, De Amicis V, et al. Preoperative intraaortic balloon pump for off-pump coronary arterial revascularization. Ann Thorac Surg, 2012, 93(3): 804-809.
13. Dyub AM, Whitlock RP, Abouzahr LL, et al. Preoperative intra-aortic balloon pump in patients undergoing coronary bypass surgery: A systematic review and meta-analysis. J Card Surg, 2008, 23(1): 79-86.
14. Diez C, Silber RE, Wächner M, et al. EuroSCORE directed intraaortic balloon pump placement in high-risk patients undergoing cardiac surgery--retrospective analysis of 267 patients. Interact Cardiovasc Thorac Surg, 2008, 7(3): 389-395.
15. Shi M, Huang J, Pang L, et al. Preoperative insertion of an intra-aortic balloon pump improved the prognosis of high-risk patients undergoing off-pump coronary artery bypass grafting. J Int Med Res, 2011, 39(4): 1163-1168.
16. Pilarczyk K, Boening A, Jakob H, et al. Preoperative intra-aortic counterpulsation in high-risk patients undergoing cardiac surgery: A meta-analysis of randomized controlled trials. Eur J Cardiothorac Surg, 2016, 49(1): 5-17.
17. Deppe AC, Weber C, Liakopoulos OJ, et al. Preoperative intra-aortic balloon pump use in high-risk patients prior to coronary artery bypass graft surgery decreases the risk for morbidity and mortality--A meta-analysis of 9, 212 patients. J Card Surg, 2017, 32(3): 177-185.
18. Poirier Y, Voisine P, Plourde G, et al. Efficacy and safety of preoperative intra-aortic balloon pump use in patients undergoing cardiac surgery: A systematic review and meta-analysis. Int J Cardiol, 2016, 207: 67-79.
19. Theologou T, Bashir M, Rengarajan A, et al. Preoperative intra aortic balloon pumps in patients undergoing coronary artery bypass grafting. Cochrane Database Syst Rev, 2011, 1: CD004472.
20. Bahekar A, Singh M, Singh S, et al. Cardiovascular outcomes using intra-aortic balloon pump in high-risk acute myocardial infarction with or without cardiogenic shock: A meta-analysis. J Cardiovasc Pharmacol Ther, 2012, 17(1): 44-56.
21. Ding W, Ji Q, Wei Q, et al. Prophylactic application of an intra-aortic balloon pump in high-risk patients undergoing off-pump coronary artery bypass grafting. Cardiology, 2015, 131(2): 109-115.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of preoperative intra-aortic balloon pump insertion in patients undergoing off-pump coronary artery bypass grafting: A retrospective cohort study

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