Outcome after the early use of intra-aortic balloon pump in coronary bypass graft surgery in cases with impaired myocardial function.

Abstract

Background: Preoperative intra-aortic balloon pump (IABP) is usually used to improve myocardial perfusion byincreasing coronary blood flow during diastole with optimal timing. Its use has debatable outcomes in cases with impaired function and need of coronary artery bypass graft surgery (CABG).Objective: This study aimed to evaluate the early use of IABP preoperatively and the predictors in cases with severe tomoderate impaired left ventricular (LV) function undergoing CABG, focusing on the outcomes.Patients and Methods: This study enrolled 129 patients who underwent CABG with moderate to severe depressed LVfunction. Depending on the preoperative LV function, the patients were classified into two groups. Group I: n=49 caseswho had their ejection fraction less than 35%, and it was subdivided into subgroups: (A) (n=26 who had preoperativeIABP inserted for them) and (B) (n=23 who did not receive IABP preoperative). Group II: n=80 cases who had ejectionfraction greater than or equal to 35%, and it was subdivided into subgroups (C) n=11 who received preoperative IABP and (D) (n=69 who did not receive preoperative IABP.Results: Morbidity, mortality rate, and incidence of complications showed significant improvement in patients whohad IABP inserted for them compared with those who did not receive IABP preoperatively. In multivariant analysis,preoperative IABP was an independent risk factor for morbidity and mortality after CABG. Meanwhile, low plateletcount was an independent risk factor for the development of complications (odds ratio: 0.975, 95% confidence interval:0.956–0.993, P=0.007) and preoperative elevation of serum creatinine level was a significant risk factor for mortality(odds ratio: 1.007, 95% confidence interval: 1.000–1.014, P=0.050).Conclusion: Among patients who underwent CABG with moderately and severely impaired LV function, preoperativeinsertion of IABP improves postoperative outcome.