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  • Title: Elective use of intra-aortic balloon pump during aortic valve replacement in elderly patients to reduce postoperative cardiac complications.
    Author: Nakahira J, Sawai T, Minami T.
    Journal: Artif Organs; 2014 Jun; 38(6):503-7. PubMed ID: 24256099.
    Abstract:
    This is a retrospective cohort study to determine if routine intra-aortic balloon pump (IABP) placement prior to aortic valve replacement in elderly patients with severe aortic stenosis without significant coronary artery stenosis reduces cardiac complications. Participants were patients aged ≥70 years without significant coronary stenosis, who had severe aortic stenosis, and were undergoing isolated aortic valve replacement. Our primary endpoint was postoperative cardiac morbidity rate as a composite of the adverse cardiac events: elevated creatine kinase with muscle and brain subunits (CK-MB)/CK (>5%), fatal ventricular arrhythmias requiring therapy, or catecholamine index of >10. Eighteen patients had elective IABP insertion prior to surgery, and 16 patients had no planned IABP insertion. One patient died (5.6%) in the elective IABP group (P = 1.0 compared with the non-IABP group). The overall rate of in-hospital death was 2.9% (1/34). In the non-IABP group, one patient had rescue IABP insertion after surgery (6.3%). The elective IABP group had a significantly lower cardiac morbidity rate than the non-IABP group (44.4 vs. 87.5%, respectively, P = 0.013). According to multivariate analysis using a logistic European system for cardiac operative risk evaluation value of >10% to define increased morbidity, elective IABP use significantly reduced cardiac morbidity (odds ratio, 0.11; 95% confidence interval, 0.02-0.67; P = 0.016). Additionally, the elective IABP group was more likely to show low CK-MB/CK than the non-IABP group (4.1 ± 1.9% vs. 6.1 ± 3.1%, respectively, P = 0.026). We concluded that among elderly aortic valve replacement patients without significant coronary artery stenosis, elective IABP use may reduce the incidence of major adverse cardiac events.
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