Original articleCardiovascularReduced Mortality in High-Risk Coronary Patients Operated Off Pump With Preoperative Intraaortic Balloon Counterpulsation
Section snippets
Patients and Methods
Since March 2000, off-pump operation has been the technique of choice at our center for all isolated coronary procedures, and it was used in 1300 consecutive patients. Between May 2000 and August 2005, we prospectively studied the insertion of preoperative Datascope system IABP (Datascope, Fairfield, CT) in 55 (4.2%) consecutive high-risk off-pump patients. During the same period, the IABP was inserted during or after the operation in 14 (1.1%) of the 1300 patients. All the procedures were done
Surgical Technique
A total of 213 anastomoses were performed: 3.87 per patient overall; 3.8 per patient in group I, and 3.9 per patient in group 2 (p = NS). Sixty-six percent of the anastomoses were arterial (66% in group I, 67% in group 2; p = NS). Exclusive arterial revascularization was obtained in 34.6% of the overall patient population (16% in group I, 50% in group 2; p < 0.05). The left anterior descending artery was grafted in all 55 cases, the circumflex artery in 48 (87.3%), and the right coronary artery
Comment
Reduction of hospital mortality after coronary revascularization in very high-risk patients remains a challenge for the cardiac team. Decreased mortality has been shown with off-pump procedures, especially in high-risk patients, by avoiding the detrimental effects of extracorporeal circulation and myocardial ischemia [9, 10, 11, 12]. However, most surgeons are reluctant to use beating heart operations in high-risk patients. The major reasons given are the difficulties for optimal coronary
References (18)
- et al.
Aggressive preoperative use of intraaortic balloon pump in elderly patients undergoing coronary artery bypass grafting
Ann Thorac Surg
(1999) - et al.
Clinical and hemodynamic criteria for use of the intra aortic balloon pump in patients requiring cardiac surgery
J Thorac Cardiovasc Surg
(1976) Preoperative intra aortic balloon pump assistance
Ann Thorac Surg
(1976)- et al.
Preoperative intraaortic balloon pump enhances cardiac performance and improves the outcome of redo CABG
Ann Thorac Surg
(1997) - et al.
Usefulness of preoperative intraaortic balloon pump therapy during off-pump coronary artery bypass grafting in high-risk patients
Ann Thorac Surg
(2004) - et al.
Multivessel off-pump revascularization in octogenarians: early and midterm outcomes
Ann Thorac Surg
(2003) - et al.
A prospective evaluation of hemodynamic instability during off-pump coronary artery bypass surgery
J Cardiothorac Vasc Anesth
(2003) - et al.
Coronary revascularization without cardiopulmonary bypass versus the conventional approach in high-risk patients
Ann Thorac Surg
(2005) - et al.
Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting
J Thorac Cardiovasc Surg
(2003)
Cited by (27)
Emergency Off-Pump Coronary Artery Bypass Graft Surgery for Patients on Preoperative Intraaortic Balloon Pump
2016, Annals of Thoracic SurgeryCitation Excerpt :It is well known that peripheral arterial disease could represent global vasculopathy, which has an adverse effect not only on operative survival but also on late survival [15]. Regarding repeat reintervention, few reports are available on late repeat revascularization after emergency OPCABG in ACS patients preoperatively on IABP support [3, 11, 16]. In the present study, reintervention-free survival (84.2% at 5 years and 79.5% at 10 years) was comparable with the OPCABG analyses in the earlier literature [11, 17]; and preoperative history of PCI emerged as the multivariate risk factor for repeat revascularization after OPCABG during follow-up.
Pro: Prophylactic preoperative use of an intra-aortic balloon pump is indicated in high-risk coronary patients undergoing coronary artery bypass grafting
2015, Journal of Cardiothoracic and Vascular AnesthesiaLong-term outcomes of coronary artery bypass grafting patients supported preoperatively with an intra-aortic balloon pump
2014, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :Although a consensus exists regarding IABP use in patients with cardiogenic shock and unstable conditions after an acute evolving MI, controversy remains regarding the routine use of IABP for other subgroups of high-risk patients.13 A recently published meta-analysis of 4 randomized controlled trials and 6 cohort studies of 1034 patients supported the preoperative use of IABP in high-risk patients.14 Most studies reporting the results of preoperative IABP support for CABG patients have been small, single-center, retrospective reports without long-term follow-up.
"Polarizing" microplegia improves cardiac cycle efficiency after CABG for unstable angina
2013, International Journal of CardiologyCitation Excerpt :Certainly, we demonstrated a significantly attenuated myocardial injury in UA after Mic. On the other hand, it has been reported that off-pump surgery is able to protect these acutely ischemic hearts during surgery better than cardioplegic techniques, thus determining lower perioperative troponin I leakage [3,4,29]. Although we cannot exclude that off-pump surgery may achieve similar or better results than those here reported after Mic, off-pump surgery is not considered the treatment of choice in unstable angina patients at our institution.
Preoperative intraaortic balloon pump for off-pump coronary arterial revascularization
2012, Annals of Thoracic SurgeryCitation Excerpt :The positive effect of preoperative insertion of IABP in high-risk patients is thought to be due to an improved myocardial oxygen supply/demand ratio and reduced ventricular wall stress before the operation in addition to diastolic augmentation and decreased afterload resulting in the redistribution of coronary blood flow toward the ischemic areas of the myocardium, and in the recovered energy depletion of myocardial cells [15]. As a consequence, preoperative prophylactic IABP assistance provides better hemodynamic stability in the crucial times for higher oxygen demand when the anesthesia is induced and the conduits are harvested, as well as when the heart is displaced in off-pump procedures [5, 16–18]. The optimal timing for preoperative insertion of IABP in high-risk patients undergoing CABG remains controversial, although the subject has been treated frequently in the past decade.