What effect does using a preoperative intra-aortic balloon pump (IABP) have on mortality and morbidity in people undergoing coronary artery bypass grafting (CABG)?

2014 ◽  
Author(s):  
Jane Burch ◽  
Dane Gruenebaum
Author(s):  
Kamales Kumar Saha ◽  
Ajay Kumar ◽  
Mandar Manohar Deval ◽  
Kakalee K. Saha ◽  
Rinu V. Jacob ◽  
...  

Objective Off-pump coronary artery bypass grafting in patients with left ventricular dysfunction has proven to be advantageous. However, it carries risk of emergency conversion to cardiopulmonary bypass. We have successfully used an intra-aortic balloon pump to prevent such conversion. The objective of the present study was to evaluate if intravenous nicorandil infusion reduces the incidence of intraoperative intra-aortic balloon pump insertion. Methods Consecutive cases of isolated off-pump coronary artery bypass surgery performed by a single surgeon were studied. Patients were divided into two groups. The first group did not receive nicorandil, and the second group received intraoperative nicorandil infusion (started in the operating room after central line insertion). Results A total of 375 patients were included in the study. Four patients in the non-nicorandil group and the patients in nicorandil group were on preoperative intra-aortic balloon pump and hence excluded from the study. After routine use of nicorandil infusion, incidence of intra-aortic balloon pump insertion during off-pump coronary artery bypass surgery decreased from 12.4% (21/169) to 2.9% (6/206). Conclusions Nicorandil infusion significantly (P = 0.007) reduced the incidence of intra-aortic balloon pump insertion in our series. In patients with left ventricular dysfunction (ejection fraction ≤ 30%), this difference (P = 0.008) assumes a special significance as off-pump bypass surgery is considered high risk in this subset. Nicorandil is an inexpensive drug, and the reduction in cost of surgery by avoiding intra-aortic balloon pump insertion is an added advantage. The use of nicorandil infusion during off-pump coronary artery bypass may result in favorable patient outcomes by reducing invasive intra-aortic balloon pump insertion during off-pump coronary artery bypass grafting.


2014 ◽  
Vol 3 (3) ◽  
pp. 7 ◽  
Author(s):  
Zahra Faritus ◽  
Maryam Ardeshiri ◽  
ZahraOjaghi Haghighi ◽  
Hooman Bakhshandeh ◽  
Faranak Kargar ◽  
...  

2020 ◽  
Vol 13 (1) ◽  
pp. 12-18
Author(s):  
Al Masum Ziaul Haque ◽  
Nasir Uddin Ahmed ◽  
MI Zulkarnine ◽  
Saleh Ahmed

Background: Cardiopulmonary bypass is associated with increased incidence of hyperglycemia. Many studies have shown that diabetes is associated with increased morbidity and mortality in coronary artery bypass (CABG) surgery. We reviewed the outcome of on-pump versus off pump CABG in diabetic patients. Methods- 80 Adult diabetic patients undergoing isolated CABG both on-pump and OPCAB were divided into 2 groups – 40 patients in each group. To evaluate both preoperative, perioperative and postoperative out come and to compare their in hospital outcome mortality and morbidity. Results: Diabetic patients undergoing coronary artery bypass grafting without cardiopulmonary bypass had fewer complications, including neurological dysfunction (7.5% vs. 10.0%, p=0.1), and reduced incidence of prolonged ventilation (7.5% vs. 12.5%, p = 0.709), atrial fibrillation (15.0% vs. 20.0%, p = 0.002), and renal dysfunction (10.0% vs. 17.5%, p=0.556). In postoperative period, 70% patients in OPCAB group did not experience any cardiac events whereas 30% patients developed myocardial infarction, 5% had cardiac arrest and 7.5% had low output syndrome. . In on pump group 65% patients had no cardiac events whereas 35% patients developed one or more cardiac events. Of them 20% patients developed atrial fibrillation, 2.5% developed myocardial infarction, 2.5% develop cardiac arrest and 10% had low output syndrome. 2.5% patient developed both atrial fibrillation and low output. Conclusion: Diabetic patients undergoing CABG without cardiopulmonary bypass compared with those having coronary artery bypass grafting with cardiopulmonary bypass had higher mean predicted mortality and morbidity. Cardiovasc. j. 2020; 13(1): 12-18


Perfusion ◽  
2019 ◽  
Vol 35 (2) ◽  
pp. 145-153
Author(s):  
Feng Yang ◽  
Liangshan Wang ◽  
Dengbang Hou ◽  
Jinhong Wang ◽  
Xiaomeng Wang ◽  
...  

Objectives: The benefit of preoperative intra-aortic balloon pump implantation in high-risk cardiac surgery patients is still debated. The role of preoperative intra-aortic balloon pump insertion in acute myocardial infarction patients without cardiogenic shock undergoing off-pump coronary artery bypass grafting remains unknown. This study aimed to determine the efficacy and safety of the preoperative intra-aortic balloon pump insertion in those patients undergoing off-pump coronary artery bypass grafting. Methods: A total of 421 consecutive acute myocardial infarction patients without cardiogenic shock who underwent isolated off-pump coronary artery bypass grafting were enrolled in this retrospective observational propensity score–matched analysis study. Patients who received intra-aortic balloon pump before off-pump coronary artery bypass grafting (the intra-aortic balloon pump group, n = 157) were compared with those who had not (control group, n = 264). The 30-day postoperative survival, postoperative complications, and postoperative hospital length of stay were compared between the two groups. Results: A total of 99 pairs of patients were matched. The preoperative intra-aortic balloon pump did not show a 30-day postoperative survival benefit compared with the control group (hazard ratio, 0.9; 95% confidence interval, 0.2-4.2; p = 0.92). Patients with preoperative intra-aortic balloon pump were more likely to have shorter postoperative lengths of stay (8 (6-11) days vs. 10 (6-15) days, p = 0.02) and decreased total days in the hospital (median days: 18.2 vs. 21.8, p = 0.02) compared to patients without balloon pumps. Conclusion: Preoperative intra-aortic balloon pump insertion in acute myocardial infarction patients without cardiogenic shock undergoing off-pump coronary artery bypass grafting improved convalescence as shown by significantly shorter postoperative lengths of hospital stay.


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