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Effective surgical management of high-risk coronary patients using preoperative intra-aortic balloon counterpulsation therapy

Schmuziger, M
Simonet, F
Published in Cardiovascular Surgery. 2001, vol. 9, no. 4, p. 383-90
Abstract The proportion of high-risk coronary patients submitted to surgical myocardial revascularization (CABG) is steadily increasing. High-risk patients utilize more hospital resources and have a higher procedural cost than low-moderate risk CABG patients. An efficient management is essential to improve outcome and reduce costs. This report entails three study periods. In an initial retrospective study coronary high-risk criteria were established. At least two of the following factors were required: redo CABG, unstable angina, left main stem stenosis greater than 70%, preoperative left ventricular ejection fraction < 0.30 and diffuse coronary artery disease. Poor preoperative cardiac performance was the major contributing factor for poor outcome. Intra-aortic balloon counterpulsation therapy (IABP) was introduced as preoperative therapy. During a second study period prospective randomized studies found preoperative IABP-therapy efficient, significantly improving both preoperative cardiac index (P < 0.0001), decreasing postoperative mortality (P < 0.0001) and morbidity, shorten intensive care unit stay as well as total hospital stay (P < 0.0001). Drug consumption was significantly reduced (P < 0.0001). Optimal timing was found to be 2 h prior to aortic cross-clamping and the therapy was found highly cost-beneficial with an average 36% reduction of the total procedural cost. During a third study period, well beyond any study protocol period, preoperative IABP therapy was again found highly effective with a close to 100% utilization rate in high-risk patients and continuous efficacy with excellent outcome, despite acceptance of sicker patients. During this post-study evaluation period 1/3 of the high-risk patients presented with 4 of the established risk factors. The use of preoperative IABP therapy is therefore highly recommended for high-risk coronary patients undergoing CABG.
Keywords AdultAgedAngina, Unstable/mortality/surgeryCoronary Disease/mortality/surgeryFemaleFollow-Up StudiesHeart Failure/mortality/surgeryHumansIntra-Aortic Balloon PumpingMaleMiddle AgedMyocardial Infarction/mortality/surgeryPostoperative CarePostoperative Complications/mortalityPreoperative CareProspective StudiesRandomized Controlled Trials as TopicReoperationRisk FactorsSurvival Rate
PMID: 11420164
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Research group Chirurgie cardio-vasculaire (105)
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CHRISTENSON, Jan, SCHMUZIGER, M, SIMONET, F. Effective surgical management of high-risk coronary patients using preoperative intra-aortic balloon counterpulsation therapy. In: Cardiovascular Surgery, 2001, vol. 9, n° 4, p. 383-90. doi: 10.1016/S0967-2109(00)00151-4 https://archive-ouverte.unige.ch/unige:47533

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Deposited on : 2015-03-04

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