Impact of preoperative intra-aortic balloon pump on outcomes in coronary artery bypass grafting for unprotected left-main coronary artery disease.

Autor:	Daoulah A; Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia., Elmahrouk A; Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia.; Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt., Arafat AA; Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt.; Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia., Alzahrani B; Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia., Alshehri M; Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia., Qenawi W; Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia., Elganady A; Department of Cardiology, Dr Erfan and Bagedo General Hospital, Jeddah, Kingdom of Saudi Arabia.; Department of Cardiology, Faculty of Medicine, Alazhr University, Cairo, Egypt., Almahmeed W; Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE., Jamjoom A; Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia., Elmahrouk Y; Faculty of Medicine, Tanta University, Tanta, Egypt., Qutub MA; Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia., Dahdouh Z; Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia., Yousif N; Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain., Kanbr O; Faculty of Medicine, Elrazi University, Khartoum, Sudan., Hassan T; Department of Cardiology, Bugshan General Hospital, Jeddah, Kingdom of Saudi Arabia., Chachar TS; Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain., Abohasan A; Department of Cardiology, Prince Sultan Cardiac Center, Qassim, Kingdom of Saudi Arabia., Alqahtani AM; Department of Cardiology, King Salman Heart Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia., Aldossari A; Department of Cardiology, King Salman Heart Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia., Ghani MA; Department of Cardiology, Madinah Cardiac Center, Madinah, Kingdom of Saudi Arabia., Refaat W; Department of Cardiology, Prince Sultan Cardiac Center, Al Hassa, Kingdom of Saudi Arabia., Balghith M; King Abdulaziz Cardiac Center, College of Medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Kingdom of Saudi Arabia., Kazim HM; Department of Cardiology, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia., Abdulhabeeb IAM; Department of Cardiology, King Abdulaziz Specialist Hospital, Al Jawf, Kingdom of Saudi Arabia., Aithal J; Department of Cardiology, New Medical Center Royal Hospital, Khalifa City A, Abu Dhabi, UAE., Altnji I; Department of Cardiology, St James's Hospital, Dublin, Ireland., Selim E; Department of Cardiology, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia., Hashmani S; Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE., Ibrahim AM; Department of Cardiology, Saudi German Hospital, Jeddah, Kingdom of Saudi Arabia., Abuelatta R; Department of Cardiology, Madinah Cardiac Center, Madinah, Kingdom of Saudi Arabia., Ghonim AA; Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia., Shawky AM; Department of Cardiology, Dr Erfan and Bagedo General Hospital, Jeddah, Kingdom of Saudi Arabia.; Department of Cardiology, Faculty of Medicine, Alazhr University, Cairo, Egypt., Ahmad O; Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia., Alkaluf A; Department of Cardiology, Prince Sultan Cardiac Center, Al Hassa, Kingdom of Saudi Arabia., Hussien AF; Department of Cardiology, International Medical Center, Jeddah, Kingdom of Saudi Arabia., Alama MN; Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia., Abualnaja S; Department of Cardiology, International Medical Center, Jeddah, Kingdom of Saudi Arabia., Baqais RT; Department of Cardiac Surgery, King Fahd Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia., Alhassoun A; Department of Anesthesia, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia., Elghaysha E; Department of Intensive Care, Princess Alexandra Hospital, PHAT, Harlow, UK., Al Wabisi SO; Department of Cardiology, King Khalid Military Hospital, Tabuk, Kingdom of Saudi Arabia., Algublan AN; Department of Cardiology, King Salman Heart Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia., Nasim N; Department of Cardiology, National Institute of Cardiovascular Disease, Karachi, Pakistan., Lotfi A; Department of Cardiovascular Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center, Springfield, MA, USA.
Jazyk:	angličtina
Zdroj:	Cardiovascular diagnosis and therapy [Cardiovasc Diagn Ther] 2024 Jun 30; Vol. 14 (3), pp. 340-351. Date of Electronic Publication: 2024 Jun 27.
DOI:	10.21037/cdt-23-418
Abstrakt:	Background: Preoperative intra-aortic balloon pump (IABP) before coronary artery bypass grafting (CABG) could improve operative outcomes by augmenting the diastolic coronary blood flow. Data on preoperative IABP use in patients with left-main coronary artery (LMCA) disease are limited. This study aimed to characterize patients who received preoperative IABP before CABG for LMCA and evaluate its effect on postoperative outcomes. Methods: This multicenter retrospective cohort study that included consecutive 914 patients who underwent CABG for unprotected LMCA disease from January 2015 to December 2019 in 14 tertiary referral centers. Patients were grouped according to the preoperative IABP insertion into patients with IABP (n=101) and without IABP (n=813). Propensity score matching adjusting for preoperative variables, with 1:1 match and a caliber of 0.03 identified 80 matched pairs. The primary outcomes used in propensity score matching were cardiac mortality and major adverse cardiac and cerebrovascular events (MACCE). Results: IABP was commonly inserted in patients with previous myocardial infarction (MI), chronic kidney disease, peripheral arterial disease, and congestive heart failure. IABP patients had higher EuroSCORE [ES >8%: 95 (11.86%) vs. 40 (39.60%), P<0.001] and SYNTAX {29 [interquartile range (IQR) 25-35] vs. 33 (IQR 26-36); P=0.02} scores. Preoperative cardiogenic shock and arrhythmia were more prevalent in patients with IABP, while acute coronary syndrome was more prevalent in patients without IABP. After matching, there was no difference in vasoactive inotropic score between groups [3.5 (IQR 1-7.5) vs. 6 (IQR 1-13.5), P=0.06], and lactate levels were nonsignificantly higher in patients with IABP [2.4 (IQR 1.4-4.5) vs. 3.1 (IQR 1.05-7.75), P=0.05]. There were no differences between groups in acute kidney injury [20 (25%) vs. 26 (32.5%), P=0.34], cerebrovascular accidents [3 (3.75%) vs. 4 (5%), P>0.99], heart failure [5 (6.25%) vs. 7 (8.75%), P=0.75], MI [7 (8.75%) vs. 8 (10%), P>0.99], major adverse cardiac and cerebrovascular events [10 (12.5%) vs. 17 (21.25%), P=0.21], and cardiac mortality [6 (7.50%) vs. 14 (17.50%), P=0.09]. Patients who received IABP had longer ventilation times [8.5 (IQR 6-23) vs. 15.5 (IQR 5-50.5) h, P=0.03] and intensive care unit (ICU) stays [3 (IQR 2-5) vs. 4 (IQR 2-7.5) days, P=0.01]. Conclusions: Preoperative IABP in patients with LMCA might not be associated with reduced cardiac mortality or hospital complications. IABP could increase the duration of mechanical ventilation and ICU stay, and its use should be individualized for each patient. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://cdt.amegroups.com/article/view/10.21037/cdt-23-418/coif). The authors have no conflicts of interest to declare. (2024 Cardiovascular Diagnosis and Therapy. All rights reserved.)
Databáze:	MEDLINE
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