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Intraaortic balloon pump placement in various patient populations

Department of Cardiothoracic Surgery, University Regensburg, Regensburg 93053, Germany

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

We thank Dr. Wahba for his valuable comments because he addressed several critical issues of our study [1].

We think that the exclusion of the preoperative IABP placement in the EuroSCORE calculation is justified because it is the score before IABP insertion that will influence the decision to place it. Although we proposed specific indications for IABP placement, the final decision was made on the basis of the EuroSCORE result before the IABP was inserted.

We agree with Dr. Wahba that the analysis of patients with intra- and postoperative IABP might be a negative selection and a statistical comparison seems unsound. Their mean EF was slightly higher than 40% and we should have stated that in the methods section. Indeed, these patients were not intended to receive an IABP (e.g. lowest number of emergency procedure, highest EF) and the EuroSCORE does not reflect the actual mortality. But it also shows that scoring systems that try to approximate the perioperative risk on preoperative parameter only, may, under some circumstances, not be very helpful in making statements on the actual outcome after cardiac surgery.

We included the analysis of 92 patients (from a three-year period) without any IABP support to compare the outcome between patients with and without preoperative IABP placement. The demographic data and comorbidities were quite similar compared to patients with preoperative IABP. The decision not to insert an IABP was mainly based on the surgeon's individual decision and might be influenced by several conditions (e.g. good clinical appearance, contraindications for IABP, severe peripheral vascular disease). The mortality between patients with and without IABP insertion was statistically not significant. However, the latter experienced a longer ICU- and overall hospital stay.

We agree with Dr. Wahba's suggestion for a matched pair comparison. His suggestion is one way to analyze the outcome.

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1. Diez C, Silber RE, Wachner M, Stiller M, Hofmann HS. EuroSCORE directed intraaortic balloon pump placement in high-risk patients undergoing cardiac surgery – retrospective analysis of 267 patients. Interact CardioVasc Thorac Surg 2008;7:389–397.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Claudius Diez Hans-Stefan Hofmann Permission Requests Google Scholar Articles by Diez, C. Articles by Hofmann, H.-S. PubMed PubMed Citation Articles by Diez, C. Articles by Hofmann, H.-S. Related Collections Related Article