Preoperative intraaortic balloon pumps in high-risk patients undergoing open heart surgery

Background. The use of the preoperative intraaortic balloon pump (IABP) in patients with severe left ventricular dysfunction or unstable angina with c ritical coronary anatomy is becoming more frequent as surgical casemix chan ges. The aim of this study was to determine the impact of preoperative IABP use on survival in high-risk patients having open heart surgery. Methods. Prospectively collected data for 645 consecutive patients were rev iewed. Patients receiving an IABP were identified and grouped as follows: g roup A (preoperative IABP for high-risk nonemergent cases), group B (preope rative IABP for emergent cases), and group C (intra/postoperative IABP). Ri sk-adjusted hospital mortality rates in these three groups was compared usi ng the modified Parsonnet score for preoperative risk stratification. Results. IABPs were used in 101 cases (16%). The predicted versus actual ho spital mortality rate was 20% versus 5.7% in group A, 32.1% versus 47.6% in group B, and 12.6% versus 22.2% in group C (group A vs group B, p = 0.0014 ; group A vs group C, p = 0.012). IABP-related morbidity occurred in 3% of cases (all in group C). Conclusions. Risk-adjusted mortality was significantly lower in high-risk c ases with preoperative IABPs compared with emergent cases and intraoperativ e/postoperative IABPs. We encourage the use of preoperative IABPs in select ed high-risk patients. (C) 2001 by The Society of Thoracic Surgeons.