Aged, 80 and over ; Angioplasty, Balloon, Coronary ; methods ; Brachial Artery ; Humans ; Intra-Aortic Balloon Pumping ; Male

OBJECTIVETo 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).

METHODSTotally 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.

RESULTSPerioperative 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).

CONCLUSIONSFor 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.

Coronary Artery Bypass ; Humans ; Intra-Aortic Balloon Pumping ; Myocardial Infarction ; Preoperative Care ; Retrospective Studies

Humans ; Cardiovascular Diseases/therapy* ; Consensus ; Intra-Aortic Balloon Pumping ; Extracorporeal Membrane Oxygenation ; China ; Shock, Cardiogenic

OBJECTIVETo analyze the effects of perioperative intra-aortic balloon pump (IABP) support in EuroSCORE high-risk patients undergoing cardiac surgery, and evaluate the risk factors associated with mortality and midterm survival.

METHODSFifty-eight patients with EuroSCORE of no less than 6 underwent cardiac surgery and received peri-operative IABP support, including 29 with preoperative IABP support, 21 with intra-operative IABP support, and 8 with postoperative IABP support. The patients who survived the surgeries were followed up for at least 1 year.

RESULTSComplications related to IABP support occurred in 2 cases (3.45%). The in-hospital mortality was 6.89% (4/58) in this series. Patients with intra-operative IABP had a lower ejection fraction, and those with pre-operative IABP showed more frequent unstable angina and recent myocardial infarction. The number of emergency procedures was also significantly higher in patients with pre-operative IABP support. Patients with intra- or postoperative IABP support had a longer ICU stay. The 1-year follow-up was completed in 54 patients and 4 deaths were recorded, with a 1-year survival of 86.21%. The 1-year survival rate was significantly higher in patients with preo- and intra-operative IABP support than those with post-operative IABP.

CONCLUSIONPeri-operative IABP support benefit cardiac support for cardiac surgery, and its preoperative use does not increase the surgical risk. Early prophylactic IABP support according to the EuroSCORE can improve the outcome of the high-risk cardiac surgery.

Aged ; Coronary Artery Bypass ; methods ; Female ; Humans ; Intra-Aortic Balloon Pumping ; Male ; Middle Aged ; Perioperative Period ; Retrospective Studies ; Treatment Outcome

BACKGROUNDIntra-aortic balloon counterpulsation (IABP) is a mechanical cardiac-assist device that is used for cardiac support. There are no published reports about the use of IABP in elderly Chinese patients, especially for those over 80 years old. The aim of this study was to describe the clinical outcomes, influencing factors, and complications in patients ≥80 years old and requiring IABP.

METHODSWe performed a retrospective study of 134 consecutive patients who received IABP therapy. Based on age, we defined two groups; those ≥80 years old and those <80 years old.

RESULTSThe overall mortality was 41.8%. Patients ≥80 years old had higher mortality rates than those <80 years old (47.9% vs. 30.2%). Patients ≥80 years old had fewer successful revascularizations (45.8%) and more pulmonary infections (47.9%) than patients <80 years old (60.3% and 30.2%, respectively); these differences were statistically significant. The most common non-cardiac complication was pulmonary infection. Cardiogenic shock and pulmonary infection were risk factors for all-cause, in-hospital mortality, whereas revascularization success was a negative risk factor for the ≥80 years old patients.

CONCLUSIONSIABP may be successfully and safely employed in patients ≥80 years old, having severe heart disease, with few complications. Patients ≥80 years old who need IABP therapy are less likely to have a successful revascularization and are more likely to develop pulmonary infections than patients <80 years old.

Age Factors ; Aged ; Aged, 80 and over ; Female ; Humans ; Intra-Aortic Balloon Pumping ; adverse effects ; mortality ; Male ; Middle Aged ; Retrospective Studies

Patients in acute myocardial infarction (AMI) with serious complications such as malignant ventricular arrhythmia and cardiogenic shock couldn't receive emergency percutaneous coronary intervention (PCI) procedures and had high perioperative mortality. A case of AMI patients who suffered cardiac arrest and long-term cardiopulmonary resuscitation (CPR) was admitted to the department of critical care medicine of the First People's Hospital of Foshan. With the assistance of extracorporeal membrane oxygenation (ECMO), PCI and intra-aortic balloon counterpulsation (IABP) were performed. ECMO and ventilator were successfully weaned after anti-shock, mechanical ventilation, organ support treatment. The patient was successfully treated and discharged. After 6 months of follow-up, the patient recovered well in heart function.
Extracorporeal Membrane Oxygenation ; Heart Arrest ; Humans ; Intra-Aortic Balloon Pumping ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Shock, Cardiogenic ; Treatment Outcome

Objective: To investigate the effect of gender on the efficacy of intra-aortic balloon pump(IABP) applied in patients with cardiogenic shock complicated by acute myocardial infarction(AMI). Methods: A total of 209 patients diagnosed as cardiogenic shock complicated by AMI admitted in Fuwai Hospital from June 2012 to May 2018 were enrolled in our study. We collected the data from medical records and investigated their clinical manifestation and laboratory examination and IABP support, as well as 28-day (from diagnosis of cardiogenic shock) mortality retrospectively. Kaplan-Meier survival analysis was used to compare the 28-day survival rates of patients of different genders/with or without IABP treatment. Adjustment for age, systolic blood pressure, ST segment elevation myocardial infarction, dual antiplatelet, coma, APACHEⅡ score and SAPSⅡ score, Cox regression analysis was used to detect the affect of IABP treatment on the risk of all-cause mortality in different crowd, and using Z test to evaluate the modification effect of gender on IABP treatment efficacy. Results: A total of 209 patients were included in this study, with 148 males (80 (54.05%) cases received IABP support) and 61 females (22 (36.06%) cases received IABP support). A total of 102 patients received IABP treatment. The 28-day survival rate of male patients was higher than that of females (39.2% (58/148) vs. 26.2% (16/61), Log-rank P=0.034). The 28-day survival rate of patients receiving IABP was significantly higher than that of non-IABP groups (46.1% (47/102) vs. 25.2% (27/107), Log-rank P=0.001 7). Among female patients, there was no statistically significant difference in 28-day survival rate between those who received IABP and those who did not receive IABP (P=0.889). While in male patients, the 28-day survival rate of those who received IABP was higher than that of those who did not receive IABP (51.2% (41/80) vs. 25.0% (17/68), P=0.001). The survival rate of male patients treated with IABP was higher than that of male patients who did not receive IABP, female patients who did not receive IABP and female patients who received IABP (all P<0.05). After multiple regression analysis and adjustment of confounding factors, it was found that IABP implantation can significantly reduce the 28-day mortality risk in male patients (HR=0.44, 95%CI 0.25-0.77 P=0.004). While it had no inpact on the death risk in female patients(P= 0.401). The impact of IABP implantation in patients of different genders was significantly different (Z=-2.32, P=0.020). Conclusion: In AMI patients complicating cardiogenic shock, there is a gender difference in the impact of IABP implantation on the 28-day mortality risk, and protective effects are seen only in men.
Female ; Humans ; Intra-Aortic Balloon Pumping ; Male ; Myocardial Infarction/complications* ; Retrospective Studies ; ST Elevation Myocardial Infarction ; Shock, Cardiogenic ; Treatment Outcome

BACKGROUND: Although the superior reperfusion and improved clinical outcome following angioplasty for acute myocardial infarction (AMI) have been well known, 10 to 15% of reinfarction and recurrent ischemia in hospital are main limitation of primary percutaneous transluminal coronary angioplasty (PTCA). This study was undertaken to examine the safety and feasibility of stent-supported primary angioplasty in acute myocardial infarction. METHODS: Between July 1995 and Jun. 1997, 32 patients underwent direct or rescue PTCA, including patients with cardiogenic shock. After PTCA, stenting was attempted in patient with dissection or having more than 30% of residual stenosis. Result: In patient with direct PTCA, angiographic success rate was obtained in 91% (30/32). Stenting was attempted in 15 of 30 patients. These patients had suboptimal results (8 patients), non-occlusive dissection (3 patients) and acute occlusion (2 patient). Thrombolysis in myocardial infarction (TIMI) grade 3 flow was restored in 28 patients (93%). In one patient no-reflow phenomena was observed following stent insertion. Despite intra-aortic balloon pumping, there was one death during the hopitalization due to cardiogenic shock following PTCA. Subacute stent thrombosis developed in two patients. 27 patients (90%) were event-free and clinically improved through out the follow up period (11.5+/-5.2 month). Quantitative angiography showed excellent angiographic result after stenting compared with balloon PTCA (2.4+/-0.6 mm vs. 3.4+/-0.3 mm p<0.01). CONCLUSION: After failure of initial angioplasty, coronary stenting can be a supportive therapeutic strategy. Coronary stenting results in a high degree of angiographic success, a low incidence of subacute thrombosis.
Angiography ; Angioplasty* ; Angioplasty, Balloon* ; Angioplasty, Balloon, Coronary ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Incidence ; Intra-Aortic Balloon Pumping ; Ischemia ; Myocardial Infarction* ; Reperfusion ; Shock, Cardiogenic ; Stents ; Thrombosis

OBJECTIVETo assess the value of routine intra-aortic balloon pump (IABP) support in patients with high-risk acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI).

METHODSThe clinical data of 41 patients with high-risk AMI undergoing emergency PCI with routine IABP support were retrospectively reviewed, and 38 patients paired with the former group receiving emergency PCI for high-risk AMI without IABP support at the same time were included as the control group. Thirty days after the operation, the two groups were compared for myocardial ischemic events, left ventricular function and major adverse cardiac events (MACE).

RESULTSPatients receiving IABP support had a significantly lower incidence of myocardial ischemic events than those without IABP (4.9% vs 15.8%, P<0.05), and showed greater improvement in the left ventricular function. Significant differences were also observed in the mortality rate, incidence of reinfarction and revascularization rate between the two groups, but not in the rate of MACE.

CONCLUSIONPatients undergoing PCI for high-risk acute AMI can benefit from routine IABP support in terms of improvement of left ventricular function and reduce myocardial ischemic events and the rate of MACE. These results, however, still await further confirmation by large-scale clinical trials.

Angioplasty, Balloon, Coronary ; Female ; Humans ; Incidence ; Intra-Aortic Balloon Pumping ; methods ; Male ; Middle Aged ; Myocardial Infarction ; mortality ; therapy ; Myocardial Ischemia ; Retrospective Studies ; Treatment Outcome ; Ventricular Function, Left

BACKGROUNDOutcomes in patients requiring coronary artery bypass graft (CABG) surgery have been improved with devices such as the intra-aortic balloon pump (IABP). Good coronary collateral circulation (CCC) has been shown to reduce mortality in patients with coronary artery disease (CAD). We aimed to investigate whether poor preoperative CCC grade is a predictor of in-hospital mortality in CABG surgery requiring IABP support.

METHODSFifty-five consecutive patients who were undergoing isolated first time on-pump CABG surgery with IABP support were enrolled into this study and CCC of those patients was evaluated.

RESULTSTwenty-seven patients had poor CCC and 28 patients had good CCC. In-hospital mortality rate in poor CCC group was significantly higher than good CCC group (14 (50%) vs. 4 (13%), P = 0.013). Preoperative hemoglobin level (OR: 0.752; 95% CI, 0.571-0.991, P = 0.043), chronic obstructive pulmonary disease (OR: 6.731; 95% CI, 1.159-39.085, P = 0.034) and poor CCC grade (OR: 5.750; 95% CI, 1.575±20.986, P = 0.008) were associated with post-CABG in-hospital mortality. Poor CCC grade (OR: 4.853; 95% CI, 1.124-20.952, P = 0.034) and preoperative hemoglobin level (OR: 0.624; 95% CI, 0.476-0.954, P = 0.026) were independent predictors of in-hospital mortality after CABG.

CONCLUSIONPreoperative poor CCC and hemoglobin are predictors of in-hospital mortality after CABG with IABP support.

Aged ; Collateral Circulation ; physiology ; Coronary Artery Bypass ; adverse effects ; mortality ; Female ; Hospital Mortality ; Humans ; Intra-Aortic Balloon Pumping ; adverse effects ; mortality ; Male ; Middle Aged