Xi-Wu Zhang1, Zhi-Gang Song1, Lv Wang2, Fang-Lin Lu1, Lin Han1, Liang-Jian Zou1, Ji-Bin Xu1, Zhi-Yun Xu1
1Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China, 2Department of Cardiothoracic Surgery, No. 252 hospital, Baoding, Hebei, China
Background and aim of the study: Intra-aortic balloon pump (IABP) in heart valve surgical patients is associated with a higher mortality than coronary artery bypass grafting (CABG). The study aim was to analyze the early outcome of heart valve surgical patients requiring IABP support, and to assess the risk factors for early mortality.
Methods: Among a cohort of 5,786 patients undergoing heart valve replacement without CABG, 81 (1.4%) required IABP support. Data from these latter patients were collected and analysed retrospectively, and univariate and multivariate logistic regression were applied to identify risk factors for early mortality in patients requiring IABP support.
Results: IABP was inserted in 30 patients intraoperatively, and in 51 patients postoperatively. The overall mortality was 50.6%.
Mortality in the intraoperative IABP subgroup was significantly lower than in the postoperative IABP subgroup (26.7% versus 64.7%, p = 0.001). The independent risk factors for early mortality were: age increasing by 10 years (OR 1.906, 95% CI: 1.165-3.116, p = 0.010) and pulmonary hypertension (OR 4.153, 95% CI: 1.380-12.499, p = 0.011). Intraoperative IABP insertion (OR 0.297, 95% CI: 0.100-0.876, p = 0.028) was identified as a protective factor compared to postoperative insertion.
Conclusion: The mortality of patients requiring IABP support after heart valve replacement was high. The efficacy of intraoperative IABP insertion was better than a postoperative mandatory use. Clearly, more attention should be paid to older patients or those with pulmonary hypertension, who may benefit less from IABP.
The Journal of Heart Valve Disease 2014;23:458-462
|The Use of Intra-Aortic Balloon Pump in Patients Undergoing Heart Valve Replacement: Outcome and Risk Analysis|
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