Prophylactic application of intra-aortic balloon pump for low ejection fraction patients before off-pump coronary artery bypass grafting
QU Yunfei;SUN Xiaoning;ZHANG Hongqiang;LAI Dengxiang;ZHANG Jianrong;ZHOU Suming;Department of Cardiac Surgery, Chongqing Three Gorges Central Hospital;Department of Cardiovascular Surgery,Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University;
Objective: To analyze clinical and prognosis effect of intra-aortic balloon pump(IABP) application for low ejection fraction(ejection fraction 40%) patients before undergoing off-pump coronary artery bypass grafting(OPCAB). Methods: We retrospectively analyzed clinical data of 300 low ejection fraction patients with coronary artery disease who undergoing OPCAB from January 2010 to January 2015 in Zhongshan Hospital of Fudan University. There were 140 patients underwent IABP implantation before OPCAB in study group(IABP group). We also chose another 160 patients without IABP implantation before undergoing OPCAB as the control group. The ratio of patients undergoing pump coronary artery bypass grafting intraoperative and application of ECOM after operation, postoperative low cardiac output, kidney insufficiency, morbidity, ventricular arrhythmias, trachea cannula time, time of ICU stay and duration of hospital stay, level of troponin I(CTnI) and MB isoenzyme of creatine kinase(CKMB) postoperative 1, 2 and 5 d of two groups were compared. Survival rate was evaluated 1 and 5 years after surgery. Results: The ratio of patients undergoing pump coronary artery bypass grafting intraoperative and application of ECOM after operation is significantly higher than those of the IABP group(P0.05). Postoperative trachea cannula time, time of ICU stay and duration of hospital stay of the IABP group were significantly shorter than those of the control group(P0.05). The incidence of low cardiac output, ventricular arrhythmias, kidney insufficiency of the IABP group were significantly lower than those of the control group(P0.05). The level of CTnI and CKMB postoperative 1 and 2 d were significantly lower than those of the control group(P0.05), but there was no obviously difference in level of CTnI and CKMB postoperative 5 d between two groups(P0.05). In-hospital mortality of the IABP group was significantly lower than that of the control group. The differences of survival rate were not statistically significant for 1 and 5 years after surgery between two groups(P0.05). Conclusion: Preoperative prophylactic IABP application can not only significantly ameliorate patient heart function and reduce perioperative morbidity and mortality, but also considerably reduce surgical risk and improve surgical effect of low ejection fraction patients undergoing OPCAB.