THE EFFECT OF PREOPERATIVE INTRAAORTIC BALLOON PUMP SUPPORT IN PATIENTS WITH CORONARY-ARTERY DISEASE, POOR LEFT-VENTRICULAR FUNCTION (LVEF-LESS-THAN-40-PERCENT), AND HYPERTENSIVE LV HYPERTROPHY

Poor left-ventricular function, hypertension, and left-ventricular hyp ertrophy in patients with coronary artery disease (CAD) undergoing cor onary artery bypass grafting (CABG) are associated with increased oper ative risks. Between June 1994 and March 1996, 33 patients undergoing CABG, were randomized into 2 groups. One group (IABP group, n=19) rece ived IABP treatment on average for 2 hours prior to CPB, the other gro up (control group, n=14) had no preoperative IABP, Cardiac performance was measured pre- and postoperatively by Swan-Ganz catheter. Mean age was 65 years and 90% were men. All patients had a preoperative LVEF l ess than or equal to 40% (mean 32.6 +/- 11.1%), 3-vessel disease, esta blished hypertension (WHO criteria), and LV hypertrophy (ventricular m ass greater than or equal to 136 g/m(2) [men] or greater than or equal to 110 g/m(2) [women]). ischemia time was similar in both groups whil e CPB-time was shorter in the IABP group, p < 0.05. There were no hosp ital deaths in the IABP group, but 3 in the control group suffered pos toperative low cardiac output. Nine patients (64%) in the control grou p required IABP support poskoperatively, but only 20% of the patients in the IABP group. Patients in the IABP group had a shorter ICU stay, 2.4 +/- 0.9 vs. 3.4 +/- 1.1 days, p < 0.01. Cardiac index increased si gnificantly in the IABP group prior to CPB and was higher compared to control, p < 0.001. Five min after CPB cardiac index was higher in the IABP group than in the control group, p=0.013, and continued to incre ase thereafter, while no further improvement was observed in controls. Preoperative IABP treatment in hypertensive patients with CAD, low LV EF and LV hypertrophy who are undergoing CABG is beneficial, low impro ved cardiac performance pre-and postoperatively was associated with a lower rate of hospital mortality and less postoperative morbidity, as well as shorter ICU stay. The treatment is cost-beneficial.