Objective The aim of this multicentre study was to determine whether the prophylactic use of intra aortic balloon pump (IABP) translates into better early and long term results in high risk patients undergoing cardiac surgery Methods From January 2000 to March 2009, 6121 high risk patients (EuroSCORE >8) at six different institutions, underwent cardiac surgery Propensity score computer matching was performed, based on 10 variables representing patients characteristics and preoperative risk factors to correct for and minimise selection bias (Hosmer-Lemeshow goodness of fit, p = 0 3, c = 0 94) A total of 956 patients were successfully matched and consisted of 478 pairs either undergoing preoperative IABP (group A) or not receiving IABP preoperatively (group B) Results Multivariate logistic regression (odds ratio) revealed that group B had a 64% higher risk of in hospital mortality (p = 0001), 57% higher risk of 30 day mortality ( p = 0 003), 45% higher risk of perioperative myocardial infarction ( p = 0 01), 57% higher risk of postoperative low output syndrome ( p = 0 003) 45% higher risk of intensive care unit (ICU) length of stay (p = 0 001) and 44% higher risk of hospital length of stay ( p = 0 001) Patients in group A showed, at follow up, significant improvements in left ventricular (LV) ejection fraction ( p < 0 001), wall motion score index ( p < 0 001) and LV dimensions ( p < 0 001) Five and 8 year survivals did not differ between groups (5 year survival 91 7 +/- 3 1% vs 95 +/- 2 1% in groups A and B respectively, log rank p = 0 34 8 year survival 84 3 +/- 5 5% vs 85 9 +/- 6 1% in groups A and B, respectively, log rank p = 0 2) Conclusions Prophylactic IABP support in this multicentre experience, was showed to enhance perioperative management and outcome of high risk cardiac surgery patients
Impact of prophylactic intra-aortic balloon counter-pulsation on postoperative outcome in high-risk cardiac surgery patients: A multicentre, propensity-score analysis
2010-01-01
Abstract
Objective The aim of this multicentre study was to determine whether the prophylactic use of intra aortic balloon pump (IABP) translates into better early and long term results in high risk patients undergoing cardiac surgery Methods From January 2000 to March 2009, 6121 high risk patients (EuroSCORE >8) at six different institutions, underwent cardiac surgery Propensity score computer matching was performed, based on 10 variables representing patients characteristics and preoperative risk factors to correct for and minimise selection bias (Hosmer-Lemeshow goodness of fit, p = 0 3, c = 0 94) A total of 956 patients were successfully matched and consisted of 478 pairs either undergoing preoperative IABP (group A) or not receiving IABP preoperatively (group B) Results Multivariate logistic regression (odds ratio) revealed that group B had a 64% higher risk of in hospital mortality (p = 0001), 57% higher risk of 30 day mortality ( p = 0 003), 45% higher risk of perioperative myocardial infarction ( p = 0 01), 57% higher risk of postoperative low output syndrome ( p = 0 003) 45% higher risk of intensive care unit (ICU) length of stay (p = 0 001) and 44% higher risk of hospital length of stay ( p = 0 001) Patients in group A showed, at follow up, significant improvements in left ventricular (LV) ejection fraction ( p < 0 001), wall motion score index ( p < 0 001) and LV dimensions ( p < 0 001) Five and 8 year survivals did not differ between groups (5 year survival 91 7 +/- 3 1% vs 95 +/- 2 1% in groups A and B respectively, log rank p = 0 34 8 year survival 84 3 +/- 5 5% vs 85 9 +/- 6 1% in groups A and B, respectively, log rank p = 0 2) Conclusions Prophylactic IABP support in this multicentre experience, was showed to enhance perioperative management and outcome of high risk cardiac surgery patients
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