Cardiovascular Journal of Africa: Vol 26 No 3 (May/June 2015)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 3, May/June 2015

130

AFRICA

Analysis of clinical outcomes of intra-aortic balloon

pump during coronary artery bypass surgery

Gunduz Yumun, Ufuk Aydin, Yusuf Ata, Faruk Tokta

, Arda Aybars Pala, Ahmet Fatih Ozyazicioglu,

Tamer Turk, Senol Yavuz

Abstract

Aim:

The mortality rate in coronary artery bypass surgery

increases with advancing patient age. This study was conduct-

ed to analyse and compare older (above 65 years of age) with

younger patients (below 65 years of age) who had undergone

coronary artery bypass surgery and had an intra-aortic

balloon pump (IABP) inserted, comparing hospital stay, clini-

cal features, intensive care unit stay, postoperative complica-

tions, and morbidity and mortality rates.

Methods:

One hundred and ninety patients who had under-

gone coronary artery bypass surgery and required IABP

support were enrolled in this study. Patients younger than

65 years of age were considered young, and the others were

considered old. Ninety-two patients were young and 98 were

old. The mortality rates, pre-operative clinical characteristics,

postoperative complications, and duration of intensive care

unit and hospital stays 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 patient 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

(

0.043)]. The cross-clamp time, mean ejection fraction,

cardiopulmonary bypass time, and length of stay in the

intensive care unit were similar among the groups (

0.05).

Cardiopulmonary bypass time was the single independent

risk factor for mortality in both groups.

Conclusion:

In this study, high mortality rates in the post-

operative period were similar to prior studies regarding

IABP support. The complication rates were higher in the

older patient group. Prolonged cardiopulmonary bypass 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;

: 130–133

www.cvja.co.za

DOI: 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 necessary amount of time for heart recovery 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 thrombocytopenia.

4,5

In-hospital mortality

and 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 elderly population is 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.

Although several studies have shown a

significant increase in surgical mortality of elderly patients,

there have been no studies regarding clinical outcomes of IABP

in elderly patients.

In the present study, we aimed to analyse and compare older

with younger patients, regarding clinical features, postoperative

complications, intensive care unit and hospital stays, and

morbidity and mortality rates in patients who had undergone

CABG 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 required IABP support following CABG. Among these

patients, IABP was used intra-operatively for 190 patients. One

hundred and thirty-eight of the patients were male, and the mean

patient age was 62.7

9.9 years. The demographic characteristics

of the patients are summarised in Table 1.

All of the patients were operated on with standard CPB under

general anaesthesia. Antegrade cardioplegia was used for cardiac

protection. In all cases, an IABP catheter was inserted through

the common femoral artery.

In this study, IABP was used intra-operatively when weaning

from CPB failed. Pre-operative IABP was used in cases of

low cardiac output, unstable refractory angina, or persistent

Department of Cardiovascular Surgery, Namik Kemal

University, Tekirdag, Turkey

Gunduz Yumun, MD,

gunduzyumun@gmail.com

Department of Cardiovascular Surgery, Bursa Yuksek

Ihtisas Education and Research Hospital, Bursa, Turkey

Ufuk Aydin MD

Yusuf Ata MD

Faruk Tokta

Arda Aybars Pala MD

Ahmet Fatih Ozyazicioglu MD

Tamer Turk MD

Senol Yavuz MD