EFFICACY AND COST-EFFECTIVENESS OF PREOPERATIVE IABP IN PATIENTS WITHEJECTION FRACTION OF 0.25 OR LESS

Background. The purposes of this study are to determine whether patien ts with severe left ventricular dysfunction benefit from prophylactic insertion of an intraaortic balloon pump and to evaluate its cost-effe ctiveness. Methods. Between January 1991 and December 1995, 163 consec utive patients with a left ventricular ejection fraction of 0.25 or le ss underwent isolated coronary artery bypass grafting. An intraaortic balloon pump was inserted before operation in 37 patients (group A). T he remaining 126 patients underwent operation without preoperative ins ertion of the device (group 8). Preoperatively, 91.9% (34/37) of group A patients and 54.8% (69/126) of group B patients were in New York He art Association functional class III or IV (p < 0.001). Results. The 3 0-day mortality rate was 2.7% (1/37) and 11.9% (15/126) for groups A a nd B, respectively (p < 0.005). All deaths occurred in patients in fun ctional class III or IV. In group B, 28 patients (22.2%) required an i ntraaortic balloon pump after cardiotomy for low cardiac output, 42.9% (12/28) of whom died. Median postoperative hospital stay was 9.9 days and 12.0 days, and mean hospital charges were $50,627 and $54,818 for survivors in groups A and B, respectively (p = not significant). Conc lusions. Our experience suggests that patients with severe left ventri cular dysfunction undergoing coronary artery bypass grafting may benef it from preoperative intraaortic balloon pump insertion, especially pa tients in functional class III or IV. This approach improved survival significantly, reduced hospital stay, and was more cost-effective.