PREOPERATIVE INTRAAORTIC BALLOON PUMP ENHANCES CARDIAC-PERFORMANCE AND IMPROVES THE OUTCOME OF REDO CABG

Background. Reoperative coronary artery bypass grafting (redo CABG) is associated with an increased operative risk compared with primary CAB G. Because the hospital mortality in redo CABG is known to be influenc ed by poor left ventricular function (left ventricular ejection fracti on less than or equal to 0.40), unstable angina, and left main stem st enosis greater than or equal to 70%, a preoperative intraaortic balloo n pump (IABP) support could be beneficial to improve the outcome in hi gh-risk redo CABG. Methods. Between June 1994 and October 1996, 48 hig h-risk patients underwent redo CABG and were randomized into the follo wing groups: group 1 (24 patients) who received preoperative IABP trea tment on average 2 hours before cardiopulmonary bypass, and group 2 (2 4 patients) who received no preoperative IABP and served as controls. Mean age was 65 years and 90% (43 patients) were men. Forty-one patien ts had preoperative left ventricular ejection fraction less than or eq ual to 0.40 (85%), 38% (18 patients) had left main stem stenosis great er than or equal to 70%, and 54% (26 patients) had unstable angina pre operatively. Preoperative patient characteristics did not differ betwe en the groups. Results. The time on cardiopulmonary bypass was shorter in group 1, 86 versus 110 minutes (p = 0.006). There were no hospital deaths in group 1, but four deaths occurred in the control group (p = 0.049). Cardiac index rose significantly preoperatively after introdu ction of the IABP in group 1. Cardiac index was significantly higher p ostoperatively in group 1 compared with group 2 and remained significa ntly higher during the first 24 hours after cardiopulmonary bypass. Si gnificantly fewer patients in the IABP group had postoperative low car diac output (4 versus 13 patients). Nine patients in group 2 required IABP support postoperatively for 4.1 +/- 1.7 days. Only 2 patients in group 1 needed IABP postoperatively, and their IABPs were successfully removed on the first postoperative day. The preoperative IABP-support ed patients had a shorter intensive care unit stay, 2.4 +/- 0.8 days c ompared with group 2, 4.5 +/- 2.2 days (p = 0.007), as well as a short er hospital stay. The preoperative IABP treatment was found to be cost -effective. Conclusions. Preoperative treatment with IABP in high-risk redo CABG patients is an effective modality to prepare these patients to have their myocardial revascularization in an as nonischemic situa tion as possible, which resulted in a significantly lower hospital mor tality, fewer instances of postoperative low cardiac output, and short er stays in both the intensive care unit and the hospital.