Elective intraaortic balloon counterpulsation for high-risk off-pump coronary artery bypass operations

Background. Dislocations of the heart required for exposure and constructio n of distal anastomoses often produce hemodynamic instability when performi ng coronary artery revascularization without using cardiopulmonary perfusio n (OPCAB). We report our early experience with elective intraaortic balloon counterpulsation (IABP) to enable and facilitate selected high-risk patien ts to undergo OPCAB. Methods. Sixteen high-risk patients undergoing multivessel OPCAB using elec tive IABP are reported. The patients were believed to be at increased risk because of the presence of severe proximal multivessel coronary artery obst ruction, ventricular dysfunction, recent acute myocardial infarction, cardi omegaly-cardiomyopathy, and documented cerebral vascular disease. The prese nce of significant comorbid disease also made the avoidance of cardiopulmon ary bypass desirable, if at all possible, in all patients. Results. The IABP appeared to facilitate the intraoperative management of o ur series of patients. This was evidenced by improved hemodynamic stability and virtual elimination of the need for inotropic support during the dislo cations of the heart needed for exposure and construction of distal anastom oses. There were no complications related to use of IABP. There was one dea th. Conclusions. We believe this strategy to use IABP selectively can allow sur geons to safely extend the benefits of OPCAB procedures to high-risk patien ts and avoid dangerous hemodynamic instability that otherwise, often occurs . (C) 2001 by The Society of Thoracic Surgeons.