Preoperative Intra-Aortic Balloon Pumps in Cardiac Surgery: A Propensity Score Analysis
| Autor: | Warren Pavey, Molly Gilfillan, Robert Larbalestier, Girish Dwivedi, U. Ali, J. James Edelman, Kwok M. Ho, Chris Merry, Eric K. Slimani, Nick S.R. Lan |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
Inotrope medicine.medical_specialty medicine.medical_treatment 030204 cardiovascular system & hematology Logistic regression Balloon 03 medical and health sciences 0302 clinical medicine Preoperative Care medicine Humans 030212 general & internal medicine Cardiac Surgical Procedures Propensity Score Retrospective Studies Intra-aortic balloon pump Intra-Aortic Balloon Pumping Ejection fraction business.industry Australia Surgery Cardiac surgery Treatment Outcome medicine.anatomical_structure Propensity score matching Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | Heart, Lung and Circulation. 30:758-764 |
| ISSN: | 1443-9506 |
| DOI: | 10.1016/j.hlc.2020.09.924 |
| Popis: | The role of intra-aortic balloon pumps (IABP) in high-risk patients undergoing coronary artery bypass graft (CABG) surgery remains controversial. We report the 5-year experience from a new Australian centre.We retrospectively analysed 690 patients undergoing urgent isolated CABG surgery at a Western Australian tertiary centre from February 2015 to May 2020. De-identified data was obtained from the AustraliaNew Zealand Society of Cardiothoracic Surgeons database. Patients were stratified according to preoperative IABP use. A propensity score was created for the probability of IABP use and a propensity adjusted analysis was performed using logistic regression. The primary outcome was 30-day mortality. Secondary outcomes were postoperative inhospital outcomes.Preoperative IABP was used in 78 patients (11.3%). After propensity score adjustment, in a subgroup of patients with reduced ejection fraction or left main disease, 30-day mortality (7.0% vs 2.0%, OR 6.03, 95% CI 1.89-19.28, p=0.002) was significantly higher in the IABP group. Red blood cell transfusions (19.7% vs 12.6%, OR 1.86, 95% CI 1.02-3.35, p=0.039), prolonged inotrope use (78.9% vs 50.9%, OR 6.11, 95% CI 2.77-13.48, p0.001), prolonged invasive ventilation (28.2% vs 3.4%, OR 20.2, 95% CI 8.24-49.74, p0.001), mesenteric ischaemia (2.8% vs 0%, OR 4.52, 95% CI 1.15-17.77, p=0.031) and multisystem organ failure (1.3% vs 0.7%, OR 25.68, 95% CI 2.55-258.34, p=0.006) were significantly higher in the IABP group.In patients undergoing isolated CABG surgery, preoperative IABP use was associated with increased 30-day mortality and adverse outcomes. Large randomised controlled trials are required to confirm our findings. |
| Databáze: | OpenAIRE |
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