Single-Centre Experience with Perioperative Use of Intraaortic Balloon Pump in Cardiac Surgery

Machine learning-based model development for predicting risk factors of prolonged intra-aortic balloon pump therapy in patients with coronary artery bypass grafting

Machine learning algorithms are frequently used to clinical risk prediction. Our study was designed to predict risk factors of prolonged intra-aortic balloon pump (IABP) use in patients with coronary artery bypass grafting (CABG) through developing machine learning-based models. Patients who received perioperative IABP therapy were divided into two groups based on their length of IABP implantation longer than the 75th percentile for the whole cohort: normal (≤ 10 days) and prolonged (> 10 days) groups. Seven machine learning-based models were created and evaluated, and then the Shapley Additive exPlanations (SHAP) method was employed to further illustrate the influence of the features on model. In our study, a total of 143 patients were included, comprising 56 cases (38.16%) in the prolonged group. The logistic regression model was considered the final prediction model according to its most excellent performance. Furthermore, feature important analysis identified left ventricular end-systolic or diastolic diameter, preoperative IABP use, diabetes, and cardiac troponin T as the top five risk variables for prolonged IABP implantation in patients. The SHAP analysis further explained the features attributed to the model. Machine learning models were successfully developed and used to predict risk variables of prolonged IABP implantation in patients with CABG. This may help early identification for prolonged IABP use and initiate clinical interventions.

Intra-aortic balloon pump postcardiac surgery: A literature review

Intra-aortic balloon pump (IABP) has been the most commonly used mechanical assist circulatory device in many postcardiotomy low output disorders for decades. Mechanism of IABP is based on its inflation in time of the diastolic pressure in the aortic root resulting increase in the blood and oxygen amount of the coronary artery and its deflation in left ventricular afterload during the systolic period. Prophylactic and postoperative application of IABP has been suggested by researchers, which has been commonly used in high-risk patients undertaking coronary artery bypass grafting surgery or percutaneous coronary intervention. Other researchers put forward the idea of the percutaneous IABP insertion throughout the left axillary artery as a reliable and relatively well-tolerated approach and also as a recovery tool to bridge patients with end-stage heart failure to heart transplantation. The current review was aimed to give further insight into routine IABP application by presenting the basic principles and trends in the incidence, management, role of IABP recovery, and long-lasting mortality outcomes in patients with cardiovascular disorders and discussing previous and current evidence.

Clinical application of intra-aortic balloon pump in patients with cardiogenic shock during the perioperative period of cardiac surgery

Intra-aortic balloon pumps (IABP) have saved many patients with cardiogenic shock during the perioperative period of cardiac surgery. However, the ideal insertion timing is controversial. In the present study, we aimed to optimize the insertion timing, in order to increase the survival rate of the patients. A total of 197 patients with cardiogenic shock during the perioperative period of cardiac surgery and implemented IABP from January 2011 to October 2015 were selected for the study. Patients were divided into five groups on the basis of application timing of IABP: 0–60, 61–120, 121–180, 181–240 and >240 min. The 30-day mortality, application rate of continuous renal replacement therapy (CRRT), duration of mechanical ventilation, duration of hospital stay and hospitalization charges were analyzed in the above groups. The risk factors related to mortality and the occurrence of IABP complications were also analyzed. The mortality in the 0–60, 61–120, 121–180, 181–240 and >240 min groups were 42.17, 36.6, 77.3, 72.7 and 79.3%, respectively. Earlier IABP insertion resulted in less patients receiving CRRT from acute renal failure and less daily hospitalization charges. However, the IABP application timing had no effect on indexes such as hospitalization duration, duration of mechanical ventilation and total hospitalization charges. Multifactor logistic regression analysis indicated that the independent risk factors of death in patients with cardiogenic shock during cardiac surgery were related to IABP support timing and vasoactive-inotropic score (VIS) before balloon insertion. In the first 120 min of cardiogenic shock during the perioperative period of cardiac surgery, IABP application decreased 30-day mortality. Mortality was related with VIS score of patients, which can be used to predict the prognosis of patients with cardiogenic shock.

Intra-aortic balloon counterpulsation in contemporary practice - where are we?

The intra-aortic balloon pump (IABP) remains the most widely used form of mechanical circulatory support in current clinical practice. This article will review the current evidence to guide IABP use, focussing on large registry and prospective, randomised data, and seek to establish appropriate roles for the IABP in contemporary practice. Despite a paucity of clinical evidence, the IABP remains a useful clinical tool in selected settings, although its routine, up-front use in relatively unselected MI populations is not supported by data. Although current evidence no longer supports routine use in certain high-risk groups, further studies of appropriately selected high-risk patients may yet demonstrate benefit in patients with moderate-severe degrees of shock.