EuroSCORE directed intraaortic balloon pump placement in high-risk patients undergoing cardiac surgery--retrospective analysis of 267 patients

Abstract

Objectives: Intraaortic balloon pump replacement (IABP) is the most widely used circulatory assist device today and is utilized in a wide range of serious cardiovascular conditions. We examined the effects on mortality of pre-, intra-, or postoperative IABP support in patients undergoing cardiac surgery compared to high-risk patients without IABP support.

Methods: Between June 2001 and April 2004, 267 patients either received preoperative IABP support (n=62), an intra- or postoperative IABP (n=113) or had no IABP (n=92). Perioperative mortality was calculated with the EuroSCORE.

Results: Patients with preoperative IABP and without IABP support had a lower ejection fraction [37 (29; 50) % and (39 (30; 53)) % vs. (50 (39; 65)) %, P = 0.0001], more frequent unstable angina (38/62 and 53/92 vs. 37/113, P = 0.0004) and recent myocardial infarctions (33/62 and 51/92 vs. 26/113, P = 0.0001). The number of emergency procedures was also significantly higher (36/62 and 65/92 vs. 27/113, P < or = 0.01). Patients with intra-, or postoperative IABP support and patients without IABP support had a longer ICU-stay [7.5 (5; 17.75)) and (7 (5; 15.5)) days vs. (6 (3; 10) days, P = 0.023, P = 0.015]. The overall hospital stay of patients without IABP [18.5 (14; 29) days] and intra-/postoperative IABP support [19, (14; 28) days] were significantly longer (P = 0.007) compared to patients with preoperative support [14 (11.5; 20.5) days]. Whereas we found a trend towards reduced mortality in high-risk non-emergency patients with preoperative support, emergency patients and patients receiving intra- and postoperative support had significantly higher mortality rates than predicted by the EuroSCORE. Both emergency and non-emergency patients without IABP insertion had a significantly higher actual mortality than predicted (29.5% vs. 13.7%, P = 0.03 and 38.1% vs. 26.3%, P < 0.0001). The overall actual mortality between patients with preoperative IABP insertion and patients without preoperative IABP did not significantly differ (14/62 vs. 29/92, P = 0.27). The EuroSCORE proved to be a valid predictor for perioperative mortality among high-risk non-emergency and emergency patients with preoperative IABP support at lower score sums, but failed at higher score sums (>8) and among patients with intra- and postoperative IABP insertion.

Conclusion: Preoperative IABP support is indicated in high-risk non-emergency patients. The benefit of preoperative IABP insertion in emergency patients and intra- and postoperative IABP support still remains controversial and needs to be elucidated in further prospective, randomized studies.