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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 4, July/August 2015
AFRICA
155
Cardiovascular Topics
Analysis of clinical outcomes of intra-aortic balloon
pump use during coronary artery bypass surgery
Gunduz Yumun, Ufuk Aydin, Yusuf Ata, Faruk Tokta
ş
, Arda Aybars Pala, Ahmet Fatih Ozyazicioglu,
Tamer Turk, Senol Yavuz
Abstract
Aim:
The mortality rate of coronary artery bypass surgery
increases with advanced patient age. This intra-aortic balloon
pump (IABP) study was conducted to compare older patients
(above 65 years of age) with younger patients (below 65 years
of age) who had undergone coronary artery bypass surgery and
had had an IABP inserted, with regard to hospital stay, clinical
features, intensive care unit stay, postoperative complications,
and mortality and morbidity rates.
Methods:
One hundred and ninety patients who had undergone
coronary artery bypass surgery and had required IABP support
were enrolled in this study. Patients younger than 65 years of
age were considered younger, and the others were considered
older. Ninety-two patients were in younger group and 98
patients were older group. The mortality rates, pre-operative
clinical characteristics, postoperative complications, and dura-
tion of intensive care unit and hospital stay of the groups were
compared. The risk factors for mortality and complications
were analysed.
Results:
One hundred and thirty-eight of the patients were male,
and the mean age was 62.7
±
9.9 years. The mortality rate was
higher in the older patient group than the younger group [34
(37.7%) and 23 (23.4 %), respectively (
p
=
0.043)]. The cross-
clamp time, mean ejection fraction, cardiopulmonary bypass
time, and length of stay in the intensive care unit were similar
between the two groups (
p
>
0.05). Cardiopulmonary bypass
time was the unique independent risk factor for mortality in
both groups.
Conclusion:
In this study, high mortality rates in the postopera-
tive period were similar to those in prior studies regarding IABP
support. The complication rates were higher in the older patient
group. Prolonged cardiopulmonary bypass time and advanced
age were determined to be significant risk factors for mortality.
Keywords:
intra-aortic balloon pump, coronary artery bypass,
mortality
Submitted 22/11/14, accepted 22/1/15
Cardiovasc J Afr
2015;
26
: 155–158
www.cvja.co.zaDOI: 10.5830/CVJA-2015-010
An intra-aortic balloon pump (IABP) increases coronary blood
flow and reduces left ventricular afterload.
1-3
It helps to increase
the required amount of time for the heart to recover in
low-cardiac output syndrome following a cardiopulmonary
bypass (CPB) or ischaemic events. In earlier reports, researchers
had suggested that postoperative heart failure was the single
indication for IABP support.
1,2
However, these indications have
widened, and the use of IABP support has recently become more
common.
Frequently reported complications of IABP include bleeding,
aorto-iliac injury and thrombocytopaenia.
4,5
In-hospital mortality
and the early mortality of patients requiring IABP support is
high, ranging from 26 to 50%, due to the cardiac problems that
initially led to the need for this support.
6,7
The size of elderly population has been continuously
increasing across the globe. Parallel with this increase, the
number of older patients being referred for coronary artery
bypass grafting (CABG) has also increased.
8
Although several
studies have shown a significant increase in surgical mortality
rates of elderly patients,
9
there have been no studies regarding
clinical outcomes of IABP use in elderly patients.
In this study, we aimed to compare older patients with younger
patients regarding clinical features, postoperative complications,
intensive care unit and hospital stays, and morbidity and
mortality rates in patients who had undergone coronary artery
bypass surgery and required IABP support.
Methods
Patients who had undergone CABG in our clinic between
2008 and 2013 were retrospectively evaluated. Patients who
had undergone combined CABG and heart valve surgery
were excluded. This study was granted the full approval of the
institutional Review Board.
Three hundred and eighty-eight (7.4%) of 4 940 consecutive
patients had required IABP support following CABG. Among
these patients, IABP was used intra-operatively for 190 patients.
Department of Cardiovascular Surgery, Namik Kemal
University, Tekirdag, Turkey
Gunduz Yumun, MD,
gunduzyumun@gmail.comDepartment of Cardiovascular Surgery, Bursa Yuksek
Ihtisas Education and Research Hospital, Bursa, Turkey
Ufuk Aydin, MD
Yusuf Ata, MD
Faruk Tokta
ş
, MD
Arda Aybars Pala, MD
Ahmet Fatih Ozyazicioglu, MD
Tamer Turk, MD
Senol Yavuz, MD