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

¹ Martin Luther University, Halle, Germany
² University Regensburg, Germany

^* To whom correspondence should be addressed. E-mail: hans-stefan.hofmann{at}klinik.uni-regensburg.de.

	Abstract

Objectives: The 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)) % versus (50 (39; 65)) %, p=0.0001), more frequent unstable angina (38/62 and 53/92 versus 37/113, p=0.0004) and recent myocardial infarctions (33/62 and 51/92 versus 26/113, p=0.0001). The number of emergency procedures was also significantly higher (36/62 and 65/92 versus 27/113, p=<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 versus (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% versus 13.7%, p=0.03 and 38.1% versus 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 versus 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. Keywords: Intraaortic balloon pump; EuroSCORE; Mortality

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