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Moreno-Angarita A, Peña D, de León JDLP, Estacio M, Vila LP, Muñoz MI, Cadavid-Alvear E. Current indications and surgical strategies for myocardial revascularization in patients with left ventricular dysfunction: a scoping review. J Cardiothorac Surg 2024; 19:469. [PMID: 39068469 PMCID: PMC11282776 DOI: 10.1186/s13019-024-02844-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/14/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Ischemic cardiomyopathy (ICM) accounts for more than 60% of congestive heart failure cases and is associated with high morbidity and mortality rates. Myocardial revascularization in patients with left ventricular dysfunction (LVD) and a left ventricular ejection fraction (LVEF) ≤35% aims to improve survival and quality of life and reduce complications associated with heart failure and coronary artery disease. The majority of randomized clinical trials have consistently excluded those patients, resulting in evidence primarily derived from observational studies. MAIN BODY We performed a scoping review using the Arksey and O'Malley methodology in five stages: 1) formulating the research question; 2) locating relevant studies; 3) choosing studies; 4) organizing and extracting data; and 5) compiling, summarizing, and presenting the findings. This literature review covers primary studies and systematic reviews focusing on surgical revascularization strategies in adult patients with ischemic left ventricular dysfunction (LVD) and a left ventricular ejection fraction (LVEF) of 35% or lower. Through an extensive search of Medline and the Cochrane Library, a systematic review was conducted to address three questions regarding myocardial revascularization in these patients. These questions outline the current knowledge on this topic, current surgical strategies (off-pump vs. on-pump), and graft options (including hybrid techniques) utilized for revascularization. Three independent reviewers (MAE, DP, and AM) applied the inclusion criteria to all the included studies, obtaining the full texts of the most relevant studies. The reviewers subsequently assessed these articles to make the final decision on their inclusion in the review. Out of the initial 385 references, 156 were chosen for a detailed review. After examining the full articles were examined, 134 were found suitable for scoping review. CONCLUSION The literature notes the scarcity of surgical revascularization in LVD patients in randomized studies, with observational data supporting coronary revascularization's benefits. ONCABG is recommended for multivessel disease in LVD with LVEF < 35%, while OPCAB is proposed for older, high-risk patients. Strategies like internal thoracic artery skeletonization harvesting and postoperative glycemic control mitigate risks with BITA in uncontrolled diabetes. Total arterial revascularization maximizes long-term survival, and hybrid revascularization offers advantages like shorter hospital stays and reduced costs for significant LAD lesions.
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Affiliation(s)
- Alejandro Moreno-Angarita
- Fundación Valle del Lili - Departamento de Cirugía - Servicio de Cirugía Cardiovascular, Carrera 98 No. 18-49, Cali, Valle del Cauca, 760032, Colombia
- Fundación Valle del Lili - Centro de Investigaciones Clínicas, Cali, Colombia
| | - Diego Peña
- Fundación Valle del Lili - Departamento de Cirugía - Servicio de Cirugía Cardiovascular, Carrera 98 No. 18-49, Cali, Valle del Cauca, 760032, Colombia.
| | | | - Mayra Estacio
- Fundación Valle del Lili - Departamento de Medicina Interna, Cali, Colombia
| | - Lidy Paola Vila
- Universidad Icesi - Departamento de Ciencias de la Salud, Cali, Colombia
| | - Maria Isabel Muñoz
- Universidad Icesi - Departamento de Ciencias de la Salud, Cali, Colombia
| | - Eduardo Cadavid-Alvear
- Fundación Valle del Lili - Departamento de Cirugía - Servicio de Cirugía Cardiovascular, Carrera 98 No. 18-49, Cali, Valle del Cauca, 760032, Colombia
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Al-Tekreeti M, Addi Palle LR, Asif H, Amin MF, Anam H, Akurathi Y, Batool S, Ali N. Comparison of Postoperative Outcomes Between Intra-aortic Balloon Pump and Levosimendan in Patients Undergoing Coronary Artery Bypass Graft: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e43627. [PMID: 37719499 PMCID: PMC10504856 DOI: 10.7759/cureus.43627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
This study was conducted to compare the postoperative outcomes between intra-aortic balloon pump (IABP) and levosimendan in patients undergoing coronary artery bypass graft (CABG) surgery. This meta-analysis was conducted following the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). For this meta-analysis, a literature search was performed on PubMed, Cochrane Central Register of Controlled Trials, and EMBASE from inception to July 15, 2023. Keywords used to search for relevant articles included "intra-aortic balloon," "levosimendan," and "cardiac surgery" along with their key terms and Medical Subject Headings (MeSH) terms. Outcomes assessed in this study included postoperative outcomes like all-cause mortality, postoperative arrhythmias, need for inotropic support, length of intensive care unit stay (ICU) in days, and duration of mechanical ventilation in hours. Other outcomes included two-hour, six-hour, and 24-hour postoperative central venous pressure (CVP), mean atrial pressure (MAP), and heart rate (HR). A total of eight studies were included in the pooled analysis. The pooled results found that the length of ICU stay and the duration of mechanical ventilation were significantly higher in patients receiving IABP. Additionally, the findings of this meta-analysis showed a higher need for inotropic support in patients receiving IABP compared to patients receiving levosimendan but the difference was statistically insignificant. However, no significant differences were found between the two groups in terms of mortality and arrhythmias. In conclusion, patients treated with levosimendan exhibited significant advantages, as they experienced shorter ICU stays and reduced duration of mechanical ventilation compared to the IABP group and less requirement for inotropic support.
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Affiliation(s)
- Marwah Al-Tekreeti
- Internal Medicine, Avalon University School of Medicine, Willemstad, CUW
| | - Lokeshwar Raaju Addi Palle
- Surgery, Kamala Children's Hospital, Chennai, IND
- General Surgery, Hackensack Meridian Health - Palisades Medical Center, North Bergen, USA
| | - Hamza Asif
- Pulmonology, Khyber Teaching Hospital, Peshawar, PAK
| | - Muhammad Fahad Amin
- Medicine, Ghurki Trust Teaching Hospital, Lahore, PAK
- Medicine, Jinnah Hospital, Lahore, PAK
| | - Hemalatha Anam
- Medicine, Apollo Institute of Medical Sciences and Research, Hyderabad, IND
| | | | - Saima Batool
- Internal Medicine, Hameed Latif Hospital, Lahore, PAK
| | - Neelum Ali
- Internal Medicine, University of Health Sciences, Lahore, PAK
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Escutia-Cuevas HH. Use of intra-aortic balloon pump during coronary artery bypass graft surgery. Current questions and few answers. J Card Surg 2021; 36:1466-1467. [PMID: 33604923 DOI: 10.1111/jocs.15436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Hector H Escutia-Cuevas
- Department of Interventional Cardiology, Regional Hospital ISSSTE Puebla, Puebla City, Mexico
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Zheng JB, Hua K, Zhang K, Zhou SY, Xu SJ, Sheng JJ, Dong R. Prophylactic intra-aortic balloon pump in patients with left main disease undergoing off-pump coronary artery bypass grafting. BMC Cardiovasc Disord 2020; 20:266. [PMID: 32493248 PMCID: PMC7268736 DOI: 10.1186/s12872-020-01554-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Preventive intra-aortic balloon pump (IABP) for high-risk patients with stable hemodynamics is controversial, and its definition of high-risk is still unclear. This study aimed to investigate the effect of prophylactic IABP on the early outcome of left main disease (LMD) patients receiving off-pump coronary artery bypass grafting (OPCABG) with stable hemodynamics. Methods From January 2013 to April 2020, 257 consecutive patients who underwent OPCABG through sternotomy were enrolled in this study. All LMD patients (greater than 70%) had stable hemodynamics (BP>100 mmHg without vasoconstrictor substance infusion). Early outcomes of 125 patients with prophylactic IABP (IABP group) and 132 patients without IABP (Control group) were compared in this study. Results IABP did not show favorable effect on the conversion to CPB (RR 0.63, 95%CI 0.05–7.89, P = 0.7211), perioperative MI (RR 0.69, 95%CI 0.22–2.12, P = 0.5163), mortality (RR 0.65, 95%CI 0.04–10.25, P = 0.7608) or the composite end of the conversion, MI and mortality (RR 0.63, 95%CI 0.23–1.74, P = 0.3747). There was greater incidence of prolonged ventilation in IABP after adjustment (RR2.16, 95%CI 1.12–4.18, P = 0.0221). There was no IABP-related mortality or limb ischemia. Conclusion No significant difference in early outcomes was observed in hemodynamically stable patients with LMD between prophylactic IABP group and control group. Prophylactic IABP may be unnecessary in patients with LMD undergoing OPCABG.
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Affiliation(s)
- Ju-Bing Zheng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, 100029, China
| | - Kun Hua
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, 100029, China
| | - Kui Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, 100029, China
| | - Shao-You Zhou
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, 100029, China
| | - Shi-Jun Xu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, 100029, China
| | - Juan-Juan Sheng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, 100029, China
| | - Ran Dong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, 100029, China.
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Escutia-Cuevas H, Suárez-Cuenca J, Espinoza-Rueda M, Macedo-Calvillo L, Castro-Gutiérrez A, García-García J, García-Ortegón M, Robledo R, Mondragón-Terán P. Preoperative Use of Intra-Aortic Balloon Pump Support Reduced 30-Day Mortality in a Population with LVEF >35% and High Surgical Risk after Coronary Artery Bypass Graft Surgery. Cardiology 2020; 145:267-274. [DOI: 10.1159/000506393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/08/2020] [Indexed: 11/19/2022]
Abstract
Introduction: The intra-aortic balloon pump (IABP) is used to prevent complications after coronary artery bypass grafting (CABG) surgery, although some results are controversial and basal ventricular function may play a role. This study assessed the benefit of preoperative use of IABP, as stratified by the ventricular function, in a population submitted to high-surgical-risk CABG. Methods: Patients >18 years old, with multiple coronary artery disease and thus candidates for CABG, were included. Cardiogenic shock, acute myocardial infarction (AMI), acute ventricle mechanical dysfunction, severe aortic regurgitation, tachyarrhythmia, massive pulmonary embolism, coagulopathy, or low life expectancy were exclusion criteria. Results: One hundred and twenty-nine patients aged 65 years old with hypertension, dyslipidemia, type 2 diabetes mellitus, and mean left ventricular ejection fraction (LVEF) 46% constituted the study population. No difference was observed at 30-day mortality endpoint (IABP vs. no IABP, 17 vs. 24%, OR 0.63, p = 0.20; AMI 25 vs. 31%, OR 0.75, p = 0.29). After LVEF stratification, the subgroup of 48 (75%) patients under IABP support and LVEF >35% had a reduced 30-day mortality risk (LVEF ≤35% vs. LVEF >35%, 37.5 vs. 10.4%, OR 0.3, p = 0.03), independently from potential confounders and showing an interaction with European System for Cardiac Operative Risk Evaluation-II (EuroSCORE-II). At secondary endpoints, IABP use was associated with a lower prevalence of acute renal failure and renal replacement therapy, but with a longer stay in the intensive care unit and longer hospitalization time. Conclusion: The preoperative use of IABP was associated with an independent reduction of 30-day mortality risk in cases with LVEF >35% in a population submitted to high-surgical-risk CABG. Likewise, the use of IABP was associated with a lower risk of postoperative renal complications.
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Peri-operative application of intra-aortic balloon pumping reduced in-hospital mortality of patients with coronary artery disease and left ventricular dysfunction. Chin Med J (Engl) 2019; 132:935-942. [PMID: 30958435 PMCID: PMC6595768 DOI: 10.1097/cm9.0000000000000178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background: There are few reports of peri-operative application of intra-aortic balloon pumping (IABP) in patients with coronary artery disease (CAD) and different grades of left ventricular dysfunction. This study aimed to analyze the early outcomes of peri-operative application of IABP in coronary artery bypass grafting (CABG) among patients with CAD and left ventricular dysfunction, and to provide a clinical basis for the peri-operative use of IABP. Methods: A retrospective analysis of 612 patients who received CABG in the General Hospital of People's Liberation Army between May 1995 and June 2014. Patients were assigned to an IABP or non-IABP group according to their treatments. Logistic regression analysis was performed to investigate the influence of peri-operative IABP implantation on in-hospital mortality. Further subgroup analysis was performed on patients with severe (ejection fraction [EF] ≤ 35%) and mild (EF = 36%–50%) left ventricular dysfunction. Results: Out of 612 included subjects, 78 belonged to the IABP group (12.7%) and 534 to the non-IABP group. Pre-operative left ventricular EF (LVEF) and EuroSCOREII predicted mortality was higher in the IABP group compared with the non-IABP group (P < 0.001 in both cases), yet the two did not differ significantly in terms of post-operative in-hospital mortality (P = 0.833). Regression analysis showed that IABP implantation, recent myocardial infarction, critical status, non-elective operation, and post-operative ventricular fibrillation were risk factors affecting in-hospital mortality (P < 0.01 in all cases). Peri-operative IABP implantation was a protective factor against in-hospital mortality (P = 0.0010). In both the severe and mild left ventricular dysfunction subgroups, peri-operative IABP implantation also exerted a protective role against mortality (P = 0.0303 and P = 0.0101, respectively). Conclusions: Peri-operative IABP implantation could reduce the in-hospital mortality and improve the surgical outcomes of patients with CAD with both severe and mild left ventricular dysfunction.
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Factors causing prolonged mechanical ventilation and peri-operative morbidity after robot-assisted coronary artery bypass graft surgery. Heart Vessels 2018; 34:44-51. [PMID: 30006655 DOI: 10.1007/s00380-018-1221-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
Abstract
Robot-assisted coronary artery bypass graft [robot-assisted (coronary artery bypass grafting (CABG)] surgery is the latest treatment for coronary artery disease. However, the surgery extensively affects cardiac and pulmonary function, and the risk factors associated with peri-operative morbidity, including prolong mechanical ventilation (PMV), have not been fully examined. In this retrospective cohort study, a total of 382 patients who underwent robot-assisted internal mammary artery harvesting with mini-thoracotomy direct-vision bypass grafting surgery (MIDCABG) from 2005 to 2012 at our tertiary care hospital were included. The definition of PMV was failure to wean from mechanical ventilation more than 48 h after the surgery. Risk factors for PMV, and peri-operative morbidity and mortality were analyzed with a multivariate logistic regression model. Forty-three patients (11.3%) developed PMV after the surgery, and the peri-operative morbidity and mortality rates were 38 and 2.6%, respectively. The risk factors for PMV were age, left ventricular ejection fraction (LVEF), the duration of one-lung ventilation for MIDCABG (beating time), and peak airway pressure at the end of the surgery. Furthermore, age and anesthesia time were found to be independent risk factors for peri-operative morbidity, whereas age, LVEF, and anesthesia time were the risk factors for peri-operative mortality. These findings may help physicians to properly choose patients for this procedure, and provide more attention to patients with higher risk after surgery to achieve better clinical outcomes.
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Liu F, Yang F, Du Z, Miao N, Zhao Y, Xu B, Hou X. Timing of Intra-Aortic Balloon Pump Placement Before Off-Pump Coronary Artery Bypass Grafting and Clinical Outcomes. Artif Organs 2017; 42:263-270. [PMID: 29119570 DOI: 10.1111/aor.13009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/19/2017] [Accepted: 07/19/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Feng Liu
- Extracorporeal Circulation Department, Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University; Beijing China
| | - Feng Yang
- Extracorporeal Circulation Department, Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University; Beijing China
| | - Zhongtao Du
- Extracorporeal Circulation Department, Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University; Beijing China
| | - Na Miao
- Extracorporeal Circulation Department, Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University; Beijing China
| | - Yanyan Zhao
- Extracorporeal Circulation Department, Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University; Beijing China
| | - Bo Xu
- Extracorporeal Circulation Department, Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University; Beijing China
| | - Xiaotong Hou
- Extracorporeal Circulation Department, Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University; Beijing China
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Deppe AC, Weber C, Liakopoulos OJ, Zeriouh M, Slottosch I, Scherner M, Kuhn EW, Choi YH, Wahlers T. 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; 32:177-185. [DOI: 10.1111/jocs.13114] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Antje-Christin Deppe
- Department of Cardiothoracic Surgery; Heart Center of the University of Cologne; Cologne Germany
| | - Carolyn Weber
- Department of Cardiothoracic Surgery; Heart Center of the University of Cologne; Cologne Germany
| | - Oliver J. Liakopoulos
- Department of Cardiothoracic Surgery; Heart Center of the University of Cologne; Cologne Germany
| | - Mohamed Zeriouh
- Department of Cardiothoracic Surgery; Heart Center of the University of Cologne; Cologne Germany
| | - Ingo Slottosch
- Department of Cardiothoracic Surgery; Heart Center of the University of Cologne; Cologne Germany
| | - Maximilian Scherner
- Department of Cardiothoracic Surgery; Heart Center of the University of Cologne; Cologne Germany
| | - Elmar W. Kuhn
- Department of Cardiothoracic Surgery; Heart Center of the University of Cologne; Cologne Germany
| | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery; Heart Center of the University of Cologne; Cologne Germany
- Center of Molecular Medicine Cologne; University of Cologne; Cologne Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery; Heart Center of the University of Cologne; Cologne Germany
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Ranjan R, Adhikary D, Mandal S, Seedher A, Adhikary AB. Outcome of coronary endarterectomy with coronary artery bypass grafting in patients with diffuse coronary artery disease in Bangladesh: A retrospective cohort study. JRSM Cardiovasc Dis 2017; 6:2048004017732658. [PMID: 28975025 PMCID: PMC5613798 DOI: 10.1177/2048004017732658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/24/2017] [Accepted: 08/29/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In this study, we aimed to review the consequences of coronary endarterectomy with coronary artery bypass grafting, and assess outcomes of this combined surgical technique for patients with diffuse coronary artery disease in a single surgeon's practice. METHODS We retrospectively reviewed outcome of 1198 endarterectomized coronary artery in 1000 patients with diffuse coronary artery disease, who have had experienced coronary endarterectomy with off pump coronary artery bypass grafting in between 2009 and 2016. RESULTS The mean age was 61.5 ± 5.5 years. Coronary endarterectomy was performed on 74.7% in the left coronary territory (43.2% left anterior descending, 26.6% diagonal, 4.9% Obtuse Marginal), and 25.3% in the right coronary territory. Post-operative intensive care unit mortality rate was 1.9%, and there were 11 (1.1%) late deaths. Mean intensive care unit stay was 36.6 ± 6.7 hours. Patients were extubated following a mean of 9.8 ± 1.25 hours. The mean duration of hospital stay was 10 ± 1 days. One-year survival rate was 97.8% and 89.5% survival rate was at 5 years follow up. However, 91.8% of patients were angina free at median follow-up of 2.5 years. CONCLUSION Coronary endarterectomy with off pump coronary artery bypass grafting is attainable and accomplishes surgical revascularization in coronary artery disease patients when there is no other alternative for sufficient revascularization.
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Affiliation(s)
- Redoy Ranjan
- Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | | | - Sabita Mandal
- Department of Community medicine, Shaheed Suhrawardy Medical College, Dhaka, Bangladesh
| | | | - Asit Baran Adhikary
- Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
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Preoperative Prophylactic Intraaortic Balloon Pump Reduces the Incidence of Postoperative Acute Kidney Injury and Short-Term Death of High-Risk Patients Undergoing Coronary Artery Bypass Grafting: A Meta-Analysis of 17 Studies. Ann Thorac Surg 2016; 101:2007-19. [PMID: 27045229 DOI: 10.1016/j.athoracsur.2015.10.078] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/14/2015] [Accepted: 10/26/2015] [Indexed: 11/20/2022]
Abstract
This meta-analysis investigated the effects of preoperative prophylactic intraaortic balloon pump placement on postoperative renal function and short-term death of high-risk patients undergoing coronary artery bypass grafting. We found that preoperative prophylactic intraaortic balloon pump support reduced the incidence of coronary artery bypass grafting-associated acute kidney injury and short-term death and dramatically decreased the incidence of postoperative renal replacement therapy by 82% compared with high-risk patients without the procedure. This is the first meta-analysis to demonstrate significant beneficial effects of preoperative prophylactic intraaortic balloon pump on renal function in high-risk patients undergoing coronary artery bypass grafting.
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Poirier Y, Voisine P, Plourde G, Rimac G, Barria Perez A, Costerousse O, Bertrand OF. 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. [DOI: 10.1016/j.ijcard.2016.01.045] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 11/27/2015] [Accepted: 01/01/2016] [Indexed: 11/16/2022]
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Tomoaki S, Tohru A. The current status of multi-arterial off-pump coronary artery bypass grafting. Surg Today 2016; 46:1-12. [PMID: 25673033 DOI: 10.1007/s00595-015-1124-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/20/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE Off-pump coronary artery bypass surgery has not become widespread because of its technical difficulty. However, especially in Asia, pioneer surgeons continue with efforts to develop the off-pump technique. METHOD By reviewing past studies, mainly retrospective single-center reports, an up-to-date profile of off-pump surgery was assembled. RESULTS Many of the past randomized trials failed to demonstrate the advantages of off-pump surgery. Although many of these were single-center retrospective studies, the data presented, mostly from world-famous surgeons, show that off-pump surgery does have advantages in high-risk patients and results in reduced rates of postoperative morbidity and equal rates of mortality in both the short- and long terms. Moreover, almost all experienced off-pump surgeons noted the benefit of multiple uses of arterial grafts, skeletonization harvesting of arterial conduits and the aorta no-touch technique. CONCLUSION The off-pump procedure has not become a standard technique performed by the average surgeon in daily practice. However, off-pump surgery will continue to provide a significant benefit to high-risk patients with coronary disease.
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Affiliation(s)
- Suzuki Tomoaki
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Otsu, Shiga, 520-2192, Japan.
| | - Asai Tohru
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Otsu, Shiga, 520-2192, Japan
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Wu S, Wan F, Zhang Z, Zhao H, Cui ZQ, Xie JY. Redo Coronary Artery Bypass Grafting: On-Pump and Off-Pump Coronary Artery Bypass Grafting Revascularization Techniques. ACTA ACUST UNITED AC 2015; 30:28-33. [DOI: 10.1016/s1001-9294(15)30005-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Single-Centre Experience with Perioperative Use of Intraaortic Balloon Pump in Cardiac Surgery. Heart Lung Circ 2014; 23:475-81. [DOI: 10.1016/j.hlc.2013.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 11/11/2013] [Accepted: 11/18/2013] [Indexed: 11/23/2022]
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Hemo E, Medalion B, Mohr R, Paz Y, Kramer A, Uretzky G, Nesher N, Pevni D. Long-term outcomes of coronary artery bypass grafting patients supported preoperatively with an intra-aortic balloon pump. J Thorac Cardiovasc Surg 2014; 148:1869-75. [PMID: 24521970 DOI: 10.1016/j.jtcvs.2013.12.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 11/13/2013] [Accepted: 12/05/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Most studies describing the outcome of coronary artery bypass grafting patients supported preoperatively with an intra-aortic balloon pump (IABP) have reported early results. The purpose of our study was to evaluate the early and long-term results. METHODS Of 2658 isolated coronary artery bypass grafting procedures performed from 1996 to 2001, 215 were supported preoperatively with an IABP. The indications for IABP insertion were cardiogenic shock in 18 (8.4%), acute evolving myocardial infarction in 38 (17.7%), clinical instability in 84 (39.1%), and critical coronary lesions in 75 (34.9%). RESULTS Operative mortality was 12.6%. The mortality of the cardiogenic shock patients was greater (22.2%; P=.174). Logistic regression analysis showed patient age (odds ratio, 1.057; 95% confidence interval, 1.010-1.108) and cardiopulmonary bypass (CPB) time (odds ratio, 1.020; 95% confidence interval, 1.008-1.031) were associated with increased operative mortality. An increased number of bypass grafts had a protective effect (odds ratio, 0.241; 95% confidence interval, 0.113-0.515). The actual early mortality was lower than the logistic EuroSCORE calculated mortality (12.6% vs 32.8%, P<.0001). The mean follow-up was 8±4 years. The Kaplan-Meier 10-year survival was 49%. The Cox adjusted overall (early and late) survival and major adverse cardiac events-free survival of the different IABP subgroups was similar. Cox analyses showed peripheral vascular disease, off-pump coronary artery bypass surgery, age, CPB time, female gender, and fewer bypass grafts were associated with decreased survival. CONCLUSIONS In patients supported preoperatively with an IABP, better early and long-term results were strongly related to younger age, a shorter CPB time, and a greater number of bypass grafts. Avoiding the use of CPB (off pump) in these emergency cases is not recommended.
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Affiliation(s)
- Eli Hemo
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Benjamin Medalion
- Department of Cardiothoracic Surgery, Rabin Medical Center, Petach Tiqva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rephael Mohr
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yossi Paz
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Kramer
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gideon Uretzky
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nachum Nesher
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dmitri Pevni
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Alsabbagh MM, Asmar A, Ejaz NI, Aiyer RK, Kambhampati G, Ejaz AA. Update on clinical trials for the prevention of acute kidney injury in patients undergoing cardiac surgery. Am J Surg 2013; 206:86-95. [PMID: 23411349 DOI: 10.1016/j.amjsurg.2012.08.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 07/05/2012] [Accepted: 08/28/2012] [Indexed: 01/11/2023]
Abstract
BACKGROUND Effective therapeutic agents for the prevention and treatment of acute kidney injury (AKI) after cardiac surgery remain elusive despite the tremendous advances in surgical techniques, technology, and understanding of disease processes. Recent developments and their effect on the incidence of AKI after cardiac surgery are discussed. DATA SOURCES Published clinical trials in PubMed, strength of evidence assessed by the guidelines of the American Family Physicians. CONCLUSIONS The definition of AKI has changed, and the focus of interventions has shifted from treatment to prevention to recovery from AKI. Antioxidants and biological agents have been added to classic armaments of hydration and diuretics in addition to tighter metabolic control to prevent AKI. Although the treatment options remain unsatisfactory, a lot of progress nevertheless continues to be made in the prevention and treatment of AKI.
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Affiliation(s)
- Mourad M Alsabbagh
- Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, P.O. Box 100224, Gainesville, FL 32610-0224, USA
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Moon C. Preoperative intra-aortic balloon pumping in high-risk cardiac surgery patients. Dimens Crit Care Nurs 2012; 31:223-7. [PMID: 22664876 DOI: 10.1097/dcc.0b013e318256d774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Intra-aortic balloon pumping increases myocardial oxygen supply and decreases myocardial oxygen demand by inflation and deflation of the balloon. This leads to increased perfusion of the coronary arteries during diastole. This technology has been used for critically ill cardiac patients for more than 30 years. The literature suggests that preoperative use of an intra-aortic balloon pump can be effective in high-risk coronary artery bypass grafting patients. Preoperative benefits of this technology may yield positive outcomes in terms of hemodynamic effect, decreased length of stay in both the intensive care unit and the hospital, and the reduction of complications. However, the intra-aortic balloon pump must be used with a profound understanding of proper mechanism and function, monitoring, and observation for potential complications. This requires excellent critical care nursing management.
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Affiliation(s)
- Chooza Moon
- 4715 Sheboygan Ave, 327, Madison, WI 53705, USA.
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Pérez Vela J, Martín Benítez J, Carrasco González M, De la Cal López M, Hinojosa Pérez R, Sagredo Meneses V, del Nogal Saez F. Guías de práctica clínica para el manejo del síndrome de bajo gasto cardíaco en el postoperatorio de cirugía cardíaca. Med Intensiva 2012; 36:e1-44. [DOI: 10.1016/j.medin.2012.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 01/07/2012] [Indexed: 01/04/2023]
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Mannacio V, Di Tommaso L, De Amicis V, Stassano P, Musumeci F, Vosa C. Preoperative Intraaortic Balloon Pump for Off-Pump Coronary Arterial Revascularization. Ann Thorac Surg 2012; 93:804-9. [DOI: 10.1016/j.athoracsur.2011.11.060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 11/21/2011] [Accepted: 11/23/2011] [Indexed: 10/14/2022]
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21
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Harling L, Athanasiou T. Reply. Ann Thorac Surg 2011. [DOI: 10.1016/j.athoracsur.2011.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Theologou T, Bashir M, Rengarajan A, Khan O, Spyt T, Richens D, Field M. Preoperative intra aortic balloon pumps in patients undergoing coronary artery bypass grafting. Cochrane Database Syst Rev 2011; 2011:CD004472. [PMID: 21249662 PMCID: PMC8094869 DOI: 10.1002/14651858.cd004472.pub3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The intra aortic balloon pump (IABP) is a mechanical assist device which improves cardiac function. The device has a well-established place in algorithms for managing low cardiac output following cardiac surgery. There is increasing evidence that certain cardiac surgery patients benefit from a period of preoperative augmentation with the intra aortic balloon pump. OBJECTIVES To determine the effect of the preoperative intra aortic balloon pump on mortality and morbidity in a number of different patients groups undergoing coronary artery bypass grafting. SEARCH STRATEGY The Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (Issue 3, 2009), MEDLINE (2000 to August 2009), EMBASE (1998 to August 2009), BIOSIS previews (1969 to August 2009) and ISI Proceedings (1990 to August 2009) were searched. References and ongoing registers of studies were checked. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials (RCTs) of any size or length were included. DATA COLLECTION AND ANALYSIS Papers were assessed for inclusion by two authors independently and differences were settled by consensus with a third author. Date are presented in the form of odds ratios (OR) and 95% confidence intervals (CI). MAIN RESULTS Six trials were included (five on-pump and one off-pump). This update adds the results of one further trial. Data from a total of 255 patients were included in the meta-analysis of mortality outcomes; all on-pump. Generally, the patients were considered as "high risk" and 132 were treated preoperatively with IABP and 123 served as controls. There were four hospital deaths in the intervention arm and 23 in the non-intervention arm (OR 0.18, 95% CI 0.08 to 0.41; P<0.0001). In a subgroup analysis, low cardiac index (<2.0 L/min/m(2)) was noted in 21 out of 105 patients in the treatment arm and 59 patients out of 88 in the non-treatment arm (OR 0.14, 95% CI: 0.08 to 0.25; P<0.00001). An off-pump versus on-pump analysis was not possible due to the limited number of off-pump studies. However a single well-conducted RCT suggested favourable effect of the preoperative IABP in off-pump patients. AUTHORS' CONCLUSIONS Evidence suggests that preoperative IABP may have a beneficial effect on mortality and morbidity in specific high risk patient groups undergoing coronary artery bypass grafting, however there are many problems with the quality, validity and generalisability of the trials. However, the available evidence is not robust enough to extend the use of IABP to truly elective, high risk patients. Defining more precisely which patient groups may benefit would be the challenge for the future.
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Affiliation(s)
- Thomas Theologou
- Department of Cardiothoracic Surgery, Nottingham City Hospital, Hucknall Road, Nottingham, UK, NG5 1PB
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Qiu Z, Chen X, Xu M, Jiang Y, Xiao L, Liu L, Wang L. Is mitral valve repair superior to replacement for chronic ischemic mitral regurgitation with left ventricular dysfunction? J Cardiothorac Surg 2010; 5:107. [PMID: 21059216 PMCID: PMC2987923 DOI: 10.1186/1749-8090-5-107] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 11/08/2010] [Indexed: 11/21/2022] Open
Abstract
Background This study was undertaken to compare mitral valve repair and replacement as treatments for ischemic mitral regurgitation (IMR) with left ventricular dysfunction (LVD). Specifically, we sought to determine whether the choice of mitral valve procedure affected survival, and discover which patients were predicted to benefit from mitral valve repair and which from replacement. Methods A total of 218 consecutive patients underwent either mitral valve repair (MVP, n = 112) or mitral valve replacement (MVR, n = 106). We retrospectively reviewed the clinical material, operation methods, echocardiography check during operation and follow-up. Patients details and follow-up outcomes were compared using multivariate and Kaplan-Meier analyses. Results No statistical difference was found between the two groups in term of intraoperative data. Early mortality was 3.2% (MVP 2.7% and MVR 3.8%). At discharge, Left ventricular end-systolic and end-diastolic diameter and left ventricular ejection fraction (LVEF) were improved more in the MVP group than MVR group (P < 0.05), however, in follow-up no statistically significant difference was observed between the MVR and MVP group (P > 0.05). Follow-up mitral regurgitation grade was significantly improved in the MVR group compared with the MVP group (P < 0.05). The Kaplan-Meier survival estimates at 1, 3, and 5 years were simlar between MVP and MVR group. Logistic regression revealed poor survival was associated with old age(#75), preoperative renal insufficiency and low left ventricular ejection fraction (< 30%). Conclusion Mitral valve repair is the procedure of choice in the majority of patients having surgery for severe ischemic mitral regurgitation with left ventricular dysfunction. Early results of MVP treatment seem to be satisfactory, but several lines of data indicate that mitral valve repair provided less long-term benefit than mitral valve replacement in the LVD patients.
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Affiliation(s)
- Zhibing Qiu
- Department of Cardiothoracic Surgery, Nanjing First Hospital affiliated to Nanjing Medical University, Nanjing Heart Institute, Nanjing, China
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Fukui T, Tabata M, Manabe S, Shimokawa T, Shimizu J, Morita S, Takanashi S. Off-pump bilateral internal thoracic artery grafting in patients with left main disease. J Thorac Cardiovasc Surg 2010; 140:1040-5. [DOI: 10.1016/j.jtcvs.2009.11.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 11/02/2009] [Accepted: 11/27/2009] [Indexed: 10/19/2022]
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Lavana JD, Fraser JF, Smith SE, Drake L, Tesar P, Mullany DV. Influence of timing of intraaortic balloon placement in cardiac surgical patients. J Thorac Cardiovasc Surg 2010; 140:80-5. [DOI: 10.1016/j.jtcvs.2009.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 08/20/2009] [Accepted: 09/17/2009] [Indexed: 10/20/2022]
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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. [PMID: 19635155 PMCID: PMC2728099 DOI: 10.1186/1749-8090-4-39] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Accepted: 07/27/2009] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of the present study was to evaluate the safety and the cost-effectiveness of using preoperative IABP as support compared with postoperative IABP treatment in coronary patients with severe left ventricular dysfunction (SLVD) who is undergoing off-pump coronary artery bypass surgery (OPCAB), including early outcomes, hospital mortality and morbidity, and mid-term follow-up outcomes. Methods Between March 2000 and December 2008, we prospectively and randomly studied the insertion of preoperative IABP in 115 (7.4%) and postoperative IABP in 106 (6.8%) of the 1560 consecutive patients. Group A is preoperative IABP therapy. Group B is postoperative IABP therapy. Results There was no significant difference in the number of grafts used between the two groups. Completeness of revascularization did not differ between the two groups. The statistically significant difference was hospital mortality (2.6% in group A vs. 3.8% in group B) (p < 0.05). And there was significant reduction in postoperative low cardiac output, malignant arrhythmia, acute renal failure and length of stay in ICU in group A, compared with group B (p < 0.05). In the two groups, six-, 12-, 24- and 48-month survival rates were similar. In the study the degree of improvement in angina and quality of life did not differ significantly between the two groups. Conclusion The use of preoperative IABP in SLVD patients undergoing OPCAB is of safety and effectiveness. The combined use of preoperative IABP and OPCAB allows complete revascularization in SLVD patients with an important reduction in operative mortality and excellent mid-term results.
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Alie RF, Hymes W, Kooperman S. Intra-aortic balloon counterpulsation in an off-pump procedure shows improved cerebral perfusion by near-infrared spectroscopy. J Cardiothorac Vasc Anesth 2009; 24:300-2. [PMID: 19553136 DOI: 10.1053/j.jvca.2009.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Indexed: 11/11/2022]
Affiliation(s)
- René F Alie
- Department of Surgery, Hardin Memorial Hospital, Elizabethtown, KY, USA.
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Imamaki M, Matsuura K, Sakurai M, Shimura H, Ishida A, Miyazaki M. Evaluation of early and midterm results of offpump coronary artery bypass in patients with left main disease. J Card Surg 2009; 24:162-6. [PMID: 19267825 DOI: 10.1111/j.1540-8191.2009.00824.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE This study evaluated the early and midterm results of offpump coronary artery bypass (OPCAB) for left main coronary artery (LMCA) stenosis. METHODS Patients treated between November 2001 and December 2006, during which isolated coronary artery bypass grafting (CABG) was performed without cardiopulmonary bypass in principle, were included. Isolated CABG was performed in 206 patients, of whom 62 (30.1%) had LMCA stenosis >50%. RESULTS The in-hospital mortality rate (LMCA stenosis > 50%, 1.6%; LMCA stenosis <or=50%, 0.7%, p = 0.512), the incidence of postoperative complications, and the midterm survival rate (LMCA stenosis succeeds50%, 86.7 +/- 5.2%/5 years, LMCA stenosis<or=50%, 89.6 +/- 3.8%/5 years, p = 0.21) did not significantly differ between the two groups. Conversion was significantly frequent in patients with LMCA stenosis >75% and severe stenosis >90% in the right coronary artery (RCA) trunk. CONCLUSIONS Patients with LMCA stenosis can undergo OPCAB safely and the midterm results are good. As conversion was significantly frequent in patients with severe LMCA and RCA trunk stenosis, adequate preparation for pump application is necessary.
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Affiliation(s)
- Mizuho Imamaki
- Department of Cardiovascular Surgery, Chiba University Hospital, Chiba, Japan.
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Imamaki M, Matsuura K, Niitsuma Y, Shimura H, Miyazaki M. Efficacy of Elective Intra-aortic Balloon Pump Therapy for High-Risk Off-Pump Coronary Artery Bypass: A Prospective Comparative Study. Ann Vasc Dis 2009; 2:109-13. [PMID: 23555368 DOI: 10.3400/avd.avdoa09006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 04/01/2009] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study evaluated the usefulness of elective intra-aortic balloon pumping (IABP) in high-risk off-pump coronary artery bypass grafting (OPCAB). MATERIALS AND METHODS From October 2002 through September 2006, total of 143 patients were operated with OPCAB. These patients were divided into two groups and clinical outcomes were compared: Group E (N = 30): Elective IABP group and Group C (N = 113): Control group, OPCAB without IABP. The criteria of elective application of IABP were severe stenosis of left main coronary artery (LMCA) or left ventricular dysfunction with an ejection fraction of less than 35%. RESULTS No significant difference was noted in the duration of ICU stay (Group E: 1.13 ± 0.43 days; Group C: 1.18 ± 0.60 days, p = 0.710), the number of patients on a respirator for 24 hours or longer after surgery (Group E: 10.0%; Group C: 5.3%, p = 0.397), hospital mortality (Group E: 0%; Group C: 0%), or the frequency of postoperative major complications between two groups. CONCLUSIONS The outcomes of OPCAB using elective IABP in high-risk patients, such as those with severe LMCA stenosis or left ventricular dysfunction, were similar to those of OPCAB in low-risk patients, suggesting the usefulness of elective IABP in OPCAB.
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Affiliation(s)
- Mizuho Imamaki
- Department of Cardiovascular Surgery, Chiba University Hospital, Chiba, Japan
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Imamaki M, Matsuura K, Niitsuma Y, Shimura H, Miyazaki M. Efficacy of Elective Intra-aortic Balloon Pump Therapy for High-Risk Off-Pump Coronary Artery Bypass: A Prospective Comparative Study. Ann Vasc Dis 2009. [DOI: 10.3400/avd.oa09006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Emergency conversion in planned off-pump coronary artery bypass grafting: Outcome of semi-elective and delayed conversions. Indian J Thorac Cardiovasc Surg 2007. [DOI: 10.1007/s12055-007-0034-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Etienne PY, Papadatos S, Glineur D, Mairy Y, El Khoury E, Noirhomme P, El Khoury G. Reduced Mortality in High-Risk Coronary Patients Operated Off Pump With Preoperative Intraaortic Balloon Counterpulsation. Ann Thorac Surg 2007; 84:498-502. [PMID: 17643622 DOI: 10.1016/j.athoracsur.2007.03.080] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Revised: 03/23/2007] [Accepted: 03/26/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND Preoperative intraaortic balloon pump (IABP) counterpulsation has better outcomes compared with perioperative or postoperative insertion in critical patients, and off-pump surgical procedures have been advocated to reduce mortality in high-risk patients. However, some surgeons are reluctant to perform beating heart operations in specific patient subgroups, including those with unstable angina or patients with low ejection fraction, because of their possible perioperative hemodynamic instability. METHODS We evaluated combined beating heart procedures and preoperative IABP in selected high-risk patients and compared our results with the predictive European System for Cardiac Operative Risk Evaluation (EuroSCORE) model. Fifty-five high-risk patients with a mean logistic EuroSCORE of 24 were prospectively enrolled and then divided into emergency (group 1, n = 25) and nonemergency (group 2, n = 30) groups. IABP was inserted immediately before operation in group 1 and the day before the procedure in group 2. RESULTS Compared with the EuroSCORE predictive model, a dramatic decrease in mortality occurred in both groups. Group I predicted mortality was 36.8%, and observed was 20%; and group 2 predicted mortality was 15.2% and observed was 0%. No specific complications from the use of IABP were encountered. During mid-term (2 years) follow-up, no patient died from a cardiac cause or required percutaneous coronary intervention or subsequent reoperation due to incomplete revascularization. CONCLUSIONS The combined use of preoperative intraaortic counterpulsation and beating heart intervention allows complete revascularization in high-risk patients with a important reduction in operative mortality and excellent mid-term results.
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Affiliation(s)
- Pierre Yves Etienne
- Department of Cardiac Surgery and Cardiology, Clinique Saint Luc, Brussels, Belgium.
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Prapas SN, Panagiotopoulos IA, Hamed Abdelsalam A, Kotsis VN, Protogeros DA, Linardakis IN, Danou FN. Predictors of prolonged mechanical ventilation following aorta no-touch off-pump coronary artery bypass surgery. Eur J Cardiothorac Surg 2007; 32:488-92. [PMID: 17651981 DOI: 10.1016/j.ejcts.2007.05.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2007] [Revised: 05/22/2007] [Accepted: 05/24/2007] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To identify parameters associated with prolonged mechanical ventilation (PMV) (>48 h) after off-pump coronary artery bypass (OPCAB) in our patient population. MATERIALS AND METHODS From February 2001 to November 2005, we operated on 1359 patients for isolated coronary revascularization with the pi-circuit technique, consisting of: (1) beating heart, (2) OPCAB, (3) aorta no-touch, (4) use of composite grafts, and (5) arterial revascularization. RESULTS From the total number of our patients, 1320 patients had been extubated within 48 h postoperatively (Group A) and 39 patients needed PMV (Group B). In our study we have found that PMV were associated with advanced age (64.74+/-9.85 Group A vs 68.43+/-10.03 Group B, p<0.02) as well as higher incidence with octogenarians (4.4% Group A vs 10.2% Group B, p=0.09). Patients with preoperative history of transient ischemic attacks (TIAs) or stroke were more likely to belong to Group B (1.5% Group A vs 7.7% Group B, p<0.02; 2.8% Group A vs 10.3% Group B, p<0.02, respectively). Preoperative intra-aortic balloon pump (IABP) insertion was associated with PMV (1.6% Group A vs 15.4% Group B, p<0.0005). Unexpectedly, neither COPD nor obesity was associated with PMV (4.9% Group A vs 7.7% Group B, p=NS, 21.7% Group A vs 23.1% Group B, p=NS, respectively). CONCLUSION In this study, PMV following aorta no-touch OPCAB was related to preoperative variables: age, octogenarians, preoperative IABP, TIA, and stroke. There was no relation between PMV and any of the operative data.
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Affiliation(s)
- Sotirios N Prapas
- Department of Cardiac Surgery, Henry Dunant Hospital, Athens, Greece
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Bedi HS, Sohal CS, Sengar BS. Elective preoperative use of intra aortic balloon counterpulsation in high risk group of coronary artery disease patients to facilitate off pump surgery. Indian J Thorac Cardiovasc Surg 2007. [DOI: 10.1007/s12055-007-0018-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Field ML, Rengarajan A, Khan O, Spyt T, Richens D. Preoperative intra aortic balloon pumps in patients undergoing coronary artery bypass grafting. Cochrane Database Syst Rev 2007:CD004472. [PMID: 17253509 DOI: 10.1002/14651858.cd004472.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The intra aortic balloon pump (IABP) is a mechanical assist device which improves cardiac function. The device has a well-established place in algorithms for managing low cardiac output following cardiac surgery. There is increasing evidence that certain cardiac surgery patients benefit from a period of preoperative augmentation with the intra aortic balloon pump. OBJECTIVES To determine the effect of the preoperative intra aortic balloon pump on mortality and morbidity in a number of different patients groups undergoing coronary artery bypass grafting. SEARCH STRATEGY Searches were performed of the following databases: Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (Issue 1 2005), MEDLINE (2000-2005) and EMBASE (1998-2005). No language restrictions were applied. SELECTION CRITERIA Randomised or controlled trials of any size or length were included. DATA COLLECTION AND ANALYSIS Papers were assessed for inclusion by two reviewers independently. Differences were settled by consensus with a third reviewer. Data were extracted and entered into RevMan 4.1, through which a meta-analysis of the data was performed. MAIN RESULTS Five randomised controlled trials were identified from a total of 765 studies (4 on-pump and 1 off-pump). Data from a total of 193 patients were included in the meta-analysis; all on-pump. Generally, the patients were designated as "high risk" . 105 patients were treated preoperatively with IABP and 88 patients served as controls. There were three hospital deaths in the intervention arm and 18 in the non-intervention arm (odds ratio (OR) 0.16; 95% confidence intervals (CI): 0.06 to 0.4; P<0.0001). Low cardiac index (<2.0 L/min/m2) was noted in 21 out of 105 patients in the treatment arm and 59 patients out of 88 in the non-treatment arm (OR 0.14; 95% CI: 0.08 to 0.25; P<0.00001). A large proportion of the control group had an IABP inserted postoperatively for low cardiac index (52 out of 88). An off-pump versus on-pump analysis was not possible due to the limited number of off-pump studies. However a single well-conducted randomised controlled trial suggested favourable effect of the preoperative IABP in off-pump patients. AUTHORS' CONCLUSIONS Available evidence suggests the preoperative intra aortic balloon pump may have a beneficial effect on mortality and morbidity in specific high risk patient groups undergoing coronary artery bypass grafting, however, the randomised evidence is from a number of small trials, with a high proportion of unstable patients, recruited at a single institution.
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Affiliation(s)
- M L Field
- Cardiothoracic Centre, Department of Cardiothoracic Surgery, Liverpool, Merseyside, UK, L14 3PE.
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Healy DG, Veerasingam D, Wood AE. EuroSCORE: Useful in Directing Preoperative Intra-Aortic Balloon Pump Placement in Cardiac Surgery? Heart Surg Forum 2006; 9:E893-6. [PMID: 17599889 DOI: 10.1532/hsf98.20061037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The placement of preoperative intra-aortic balloon pumps (IABP) in high-risk patients has been described, although controversy remains regarding the appropriate selection of these patients. The EuroSCORE is a proven predictor of operative mortality for coronary artery bypass surgery (CABG). Our objective was to assess whether patients with a preoperative IABP had a 30-day mortality consistent with their predicted mortality. METHODS Sixty-sis patients who had had an IABP sited while undergoing CABG were retrospectively identified. The additive EuroSCORE was calculated with omission of the IABP preoperative placement score of 3 points. Patients with a EuroSCORE <5 were considered low risk, and those > or = m5 as high risk. RESULTS High-risk patients with preoperative IABP placement had a significantly lower mortality (1/16, 6.25%) than predicted. The predicted versus actual mortality was 12.6% versus 6.25%. CONCLUSION Correct identification of appropriate patients who would benefit from pre-emptive placement of IABP could potentially be performed using the EuroSCORE.
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Affiliation(s)
- David G Healy
- Prof. Eoin O'Malley National Centre for Cardiothoracic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
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Vohra HA, Kanwar R, Khan T, Dimitri WR. Early and Late Outcome After Off-Pump Coronary Artery Bypass Graft Surgery With Coronary Endarterectomy: A Single-Center 10-Year Experience. Ann Thorac Surg 2006; 81:1691-6. [PMID: 16631657 DOI: 10.1016/j.athoracsur.2005.12.028] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2005] [Revised: 12/04/2005] [Accepted: 12/07/2005] [Indexed: 11/17/2022]
Abstract
BACKGROUND We aimed to review the early and late results of off-pump coronary artery bypass graft surgery (OPCABG) with coronary endarterectomy in patients undergoing surgical revascularization at our institution. METHODS Between 1995 and 2004, of 680 OPCABG patients in a single surgeon's practice (W.R.D.), 70 patients (10.29%) who underwent concomitant coronary endarterectomy were studied. The mean age was 63.6 +/- 9.29 years. Thirty-three patients (55%) were Canadian Cardiovascular Society class III or IV, and 24 patients (40%) were New York Heart Association class III or IV. Eighteen patients (35%) had impaired left ventricular function. The mean EuroSCORE of these patients was 5.9 +/- 1.8. RESULTS Fifty-seven patients (81%) underwent right coronary artery endarterectomy, and 12 patients (17%) underwent left anterior descending artery endarterectomy (8 left interior mammary arteries used as conduits). Four patients (5.7%) had two vessels endarterectomized. The mean number of grafts were 2.0 +/- 0.4. The 30-day mortality rate was 2.85% (n = 2). Three patients (4.3%) suffered from postoperative myocardial infarction, and 3 patients (4.3%) required postoperative intra-aortic balloon pump counterpulsation. Mean intensive therapy unit stay was 17.6 +/- 8.1 hours. Patients were extubated after a mean of 10.38 +/- 4.9 hours. The mean length of hospital stay was 6.1 +/- 2.0 days. Fourteen patients (20%) had postoperative atrial fibrillation, and only 1 patient (1.42%) had a transient stroke with complete recovery. There were no conversions to cardiopulmonary bypass. A mean of 0.86 +/- 0.17 units of blood were transfused postoperatively. There was one reopening for bleeding, and 1 patient had renal failure requiring hemofiltration. The median follow-up was 4.91 years, 90% of patients were angina free, and the actuarial survival at 10 years was 78.04% +/- 7.6%. CONCLUSIONS Off-pump coronary artery bypass graft survery with coronary endarterectomy is feasible and achieves surgical revascularization in patients with diffuse coronary artery disease.
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Affiliation(s)
- Hunaid A Vohra
- Department of Cardiothoracic Surgery, Coventry and Warwickshire NHS Trust, Walsgrave Hospital, Coventry, United Kingdom
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Brown JM, Poston RS, Gammie JS, Cardarelli MG, Schwartz K, Sikora JAH, Yi S, Pierson RN, Griffith BP. Off-Pump Versus On-Pump Coronary Artery Bypass Grafting in Consecutive Patients: Decision-Making Algorithm and Outcomes. Ann Thorac Surg 2006; 81:555-61; discussion 561. [PMID: 16427851 DOI: 10.1016/j.athoracsur.2005.06.081] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2004] [Revised: 06/27/2005] [Accepted: 06/28/2005] [Indexed: 11/20/2022]
Abstract
BACKGROUND Debate continues between on-pump or off-pump approach for coronary artery bypass grafting (CABG). We used off-pump coronary artery bypass grafting (OPCAB) as a tool within a decision-making algorithm driven by the patient-related factors of coronary anatomy and comorbidity. Our analysis presents this decision algorithm and describes outcomes using this approach. METHODS From January 2000 to December 2003, 592 consecutive patients undergoing isolated CABG were assigned by one surgeon to a technique: on-pump CABG or OPCAB according to (1) anatomy and (2) predicted risk. Anatomic factors against OPCAB were target vessel size less than 1.25 mm, calcification, poor quality, intramyocardial location, and multiple stenoses. Given that OPCAB could be performed safely, patients in the moderate risk range, ie, those elderly with multiple comorbidities, were preferentially treated using OPCAB. RESULTS The OPCAB group had higher predicted 30-day mortality compared with the on-pump CABG group, consistent with the protocol's intent. However, morbidity and mortality were similar between on-pump CABG and OPCAB. The OPCAB patients received the same number of internal mammary artery grafts but fewer distal grafts. Mortality and observed to expected ratios were favorable for both groups and below those The Society of Thoracic Surgeons' predicted for OPCAB. CONCLUSIONS Matching surgical strategy to patient-related factors and needs resulted in excellent outcomes. Our data support the use of a protocol based on patient characteristics to drive the surgeon's choice between an on-pump CABG or OPCAB approach. As such, OPCAB can be viewed as a tool to be used by the surgeon developing a best practice in treating coronary artery disease.
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Affiliation(s)
- James M Brown
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland 21201, USA.
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Vohra HA, Dimitri WR. Elective Intraaortic Balloon Counterpulsation in High-Risk Off-Pump Coronary Artery Bypass Grafting. J Card Surg 2006; 21:1-5. [PMID: 16426339 DOI: 10.1111/j.1540-8191.2006.00160.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The beneficial effects of intraaortic balloon pump (IABP) in CABG with cardiopulmonary bypass (CPB) have been reported. However, the benefits of insertion of IABP electively in high-risk off-pump coronary artery bypass grafting (OPCAB) have not been established. Six hundred and twenty-five patients who underwent OPCAB form the study group. High-risk patients fulfilling two or more of the following: left main stem stenosis >70%, unstable angina, and poor left ventricular function, who had elective insertion of IABP preoperatively by the open technique (group I; n = 20) were compared with a similar high-risk group that did not (group II; n = 25). There were no significant differences in risk factors between the two groups (Euroscore 5.68). The mean number of grafts was similar. Postoperatively, there were no significant differences in the need for inotropes, duration of ventilation, arrhythmias, cerebrovascular, gastrointestinal, and infective complications (p = NS). There were no IABP-related complications. Acute renal failure requiring hemofiltration was higher in group II (n = 5; p < 0.05). Four patients (16%) in group II required postoperative IABP. Although intensive care stay was longer in group I (27.6 +/- 15.3 vs. 18.6 +/- 9.1 hours; p < 0.05), patients in group I were discharged earlier from hospital. There was no difference in mortality between the two groups (n = 1 in each group). In high-risk patients undergoing OPCAB, routine preoperative insertion of IABP electively reduces the incidence of acute renal failure. In addition it avoids the need for emergency insertion postoperatively and may result in earlier discharge.
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Affiliation(s)
- Hunaid A Vohra
- Department of Cardiothoracic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Walsgrave Hospital, Coventry, United Kingdom
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Santa-Cruz RA, Cohen MG, Ohman EM. Aortic counterpulsation: A review of the hemodynamic effects and indications for use. Catheter Cardiovasc Interv 2005; 67:68-77. [PMID: 16342217 DOI: 10.1002/ccd.20552] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In the ever evolving field of cardiovascular medicine and coronary intervention, the intra-aortic balloon pump (IABP) is a mature technology, which still plays an important role. The balloon pump invasively supports patient hemodynamics by augmenting diastolic perfusion and increasing diastolic blood pressure, thereby increasing coronary perfusion and reducing afterload. Its efficacy has been demonstrated in a multitude of clinical situations, including acute coronary syndromes, high-risk coronary interventions, cardiogenic shock, and cardiovascular surgery. The potential complications of aortic counterpulsation are serious, although much lower than once feared. With proper patient selection, insertion technique, and management, the IABP is a powerful tool to assist in the treatment of patients with cardiovascular disease. This article will review the hemodynamics, indications, and complications associated with its use.
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Affiliation(s)
- Richard A Santa-Cruz
- Division of Cardiology, University of North Carolina, Chapel Hill, 27599-7075, USA.
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