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[A clinical study of preoperative prophylactic application of intra-aortic balloon pump in extreme high-risk patients undergoing coronary artery bypass grafting].

OBJECTIVE
To compare the clinical outcome between the intra-aortic balloon pump (IABP) inserted in the preoperative prophylactic condition and in the emergent condition for the patients with extreme high risks undergoing coronary artery bypass grafting (CABG).


METHODS
Totally 92 extreme high risk patients undergoing CABG combined with IABP supporting, whose European System for Cardiac Operative Risk Evaluation were equal or more than 12 points, some also undergoing surgical operations of myocardial infarction mechanical complications from January 2008 to June 2011, were analyzed retrospectively. According to the IABP established time, these patients were divided into two groups: preoperative group (57 cases) and passive group (35 cases). Items of comparison between two groups were the rate of mortality, myocardial infarction rate, severity of postoperative myocardial dysfunction and inotropic drug consumption quantity, IABP support time, respiratory support time, ICU stay time, renal function and IABP related complications.


RESULTS
Perioperative mortality and myocardial infarction rate in preoperative group (1.8%, 3.5%) were significant lower than those in passive group (11.4%, 17.1%) (χ(2) = 3.949, P = 0.047; χ(2) = 5.077, P = 0.024). Compared to passive group, the IABP support time, respiratory support time, and ICU stay time (t = 4.113-4.795); severity of postoperative myocardial dysfunction and inotropic drug consumption quantity, and renal dysfunction (χ(2) = 5.077-23.521) were decreased significantly in preoperative group (all P < 0.05). There were no significant difference in IABP related complications (P = 0.431).


CONCLUSIONS
For extreme high risk CABG patients, comparing to passive insertion of the IABP, preoperative prophylactic application of IABP shows the advantages in reducing perioperative mortality, myocardial infarction rate, inotropic drug consumption quantity, renal dysfunction, ICU stay time, respiratory support time and IABP support time.