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

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

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

BACKGROUNDPrevious studies showed that patients with cardiogenic shock (CS) from ST-elevation acute myocardial infarction (STEMI) supported by intra-aortic balloon pump (IABP) before primary percutaneous coronary intervention (PCI) decreased the risk of in-hospital mortality than patients who received IABP after PCI. However, little evidence is available on the optimal order of IABP insertion and primary PCI. The aim of this study was to investigate the impact of the sequence of IABP support and PCI and its association with major adverse cardiac and cerebrovascular events (MACCEs).

METHODSData were obtained from 218 consecutive patients with CS due to STEMI in Beijing Anzhen Hospital between 2008 and 2014, who were treated with IABP and PCI. The patients were divided into two groups: Group A in whom IABP received before PCI (n = 106) and Group B in whom IABP received after PCI (n = 112). We evaluated the myocardial perfusion using myocardial blush grade and resolution of ST-segment elevation. The primary endpoint was 12-month risk of MACCE.

RESULTSMost baseline characteristics were similar in patients between the two groups. However, patients received IABP before PCI were associated with a delay of door-to-balloon time (DBT) and higher troponin I level (P < 0.05). However, myocardial perfusion was significantly improved in patients treated with IABP before PCI (P < 0.05). Overall, IABP support before PCI was not associated with significantly lower risk of MACCE (P > 0.05). In addition, risk of all-cause mortality, bleeding, and acute kidney injury (AKI) was similar between two groups (P > 0.05). Multivariate analysis showed that DBT (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.1-4.8, P = 0.04), IABP support after PCI (OR 5.7, 95% CI 2.7-8.4, P = 0.01), and AKI (OR 7.4, 95% CI 4.9-10.8, P = 0.01) were the independent predictors of mortality at 12-month follow-up.

CONCLUSIONSEarly IABP insertion before primary PCI is associated with improved myocardial perfusion although DBT increases. IABP support before PCI does not confer a 12-month clinical benefit when used for STEMI with CS.

Aged ; Female ; Humans ; Intra-Aortic Balloon Pumping ; methods ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; methods ; Retrospective Studies ; ST Elevation Myocardial Infarction ; surgery ; Shock, Cardiogenic ; surgery ; Treatment Outcome

OBJECTIVE: To estimate the therapeutic effect and safety of intra-aortic balloon pumps (IABP) in patients with serious cardiovascular diseases. METHODS: We retrospectively analyzed the clinical data of 68 patients with serious cardiovascular diseases, who were enrolled in Hunan Provincial People's Hospital between 2009 and 2011. All patients received IABP support. The systolic blood pressure, diastolic blood pressure,heart rate, N-terminal precursor of brain natriuretic peptide (NT-proBNP), and renal function of all patients were determined before and after the IABP. Cardiac events and mortality were observed after IABP support. RESULTS: The disease in 51 patients improved after IABP support. The systolic blood pressure, diastolic blood pressure,heart rate, and NT-proBNP were significantly lower than those before the IABP. Thirty-seven patients with acute myocardial infarction successfully completed percutaneous coronary intervention surgery after the IABP support. Five patients had IABP-related complications, but no serious complication occurred. CONCLUSION IABP is an effective and safe procedure for critical cardiovascular patients. IABP should be applied early for the patients with appropriate indications.
Aged ; Cardiomyopathies ; surgery ; therapy ; Critical Illness ; Female ; Humans ; Intra-Aortic Balloon Pumping ; methods ; Male ; Middle Aged ; Myocardial Infarction ; surgery ; therapy ; Retrospective Studies

Pheochromocytoma is a rare disorder and functioning tumor composed of chromaffin cells that secrete catecholamines. Patients with a pheochromocytoma 'crisis' have a high mortality in spite of aggressive therapy. We present a case with a severe acute catecholamine cardiomyopathy presenting ST segment elevation with cardiogenic shock after hemorrhage into a left suprarenal tumor. Intra-aortic balloon pump (IABP) support, combined with inotropic therapy, was performed. However, the patient deteriorated rapidly and was unresponsive to a full dose of inotropics and IABP. We decided to apply extracorporeal membrane oxygenation (ECMO) device for the patient. His clinical state began to improve 3 days after ECMO. After achieving hemodynamic stabilization, he underwent successful laparoscopic left adrenalectomy. He needed no further cardiac medication after discharge.
Adrenal Glands/pathology ; Adult ; Cardiomyopathies/*diagnosis/*etiology ; Catecholamines/*adverse effects ; Coronary Angiography/methods ; Diagnosis, Differential ; Electrocardiography/methods ; Extracorporeal Membrane Oxygenation/*methods ; Humans ; Intra-Aortic Balloon Pumping ; Male ; Myocardial Infarction/*diagnosis ; Pheochromocytoma/*therapy ; Time Factors ; Tomography, X-Ray Computed/methods

OBJECTIVE: To review the indications and effect of the intra-aortic balloon pump (IABP) in 38 patients during the cardiac surgery. METHODS: From June 2004 to August 2007, 38 patients were performed IABP in the cardiac surgery, including 28 coronary artery bypass grafting (CABG) and 10 valve replacements. The intra-operation prophylactic use of IABP was in 5 cases, the use of IABP for weaning from cardiopulmonary bypass (CPB) during the cardiac surgery was in 22 cases, and the rest use of IABP was after the operation in the intensive care unit. Low molecular weight heparin was used for IABP anticoagulation. RESULTS: Thirteen died out of the 38 IABP patients. The total IABP success rate was 66%.The IABP success rate in CABG was 82%, and 20% in the valve replacement. The patients with intra-operation prophylactic use of IABP all recovered, and 16 recovered out of the 22 patients with IABP uses for weaning from CPB, and 6 recovered out of the 11 patients with post-operation IABP application. No severe complications related to IABP occurred. CONCLUSION IABP has better effect in CABG patients than in valve replacements. Effect of the prophylactic use of IABP is better than both the IABP use for weaning from CPB or the post-operation IABP application. For IABP anticoagulation, low molecular weight heparin is the better alternative than routine heparin, and the proper ACT is controlled at 150-170 s.
Adult ; Aged ; Anticoagulants ; therapeutic use ; Coronary Artery Bypass ; methods ; Coronary Disease ; surgery ; Female ; Heart Valve Diseases ; surgery ; Heart Valve Prosthesis Implantation ; methods ; Heparin, Low-Molecular-Weight ; therapeutic use ; Humans ; Intra-Aortic Balloon Pumping ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Objective: To investigate the impact of combined use and timing of arterial-venous extracorporeal membrane oxygenation (VA-ECMO) with intra-aortic balloon pump (IABP) on the prognosis of patients with acute myocardial infarction complicated with cardiogenic shock (AMICS). Methods: This was a prospective cohort study, patients with acute myocardial infarction and cardiogenic shock who received VA-ECMO support from the Heart Center of Lanzhou University First Hospital from March 2019 to March 2022 in the registration database of the Chinese Society for Extracorporeal Life Support were enrolled. According to combination with IABP and time point, patients were divided into VA-ECMO alone group, VA-ECMO+IABP concurrent group and VA-ECMO+IABP non-concurrent group. Data from 3 groups of patients were collected, including the demographic characteristics, risk factors, ECG and echocardiographic examination results, critical illness characteristics, coronary intervention results, VA-ECMO related parameters and complications were compared among the three groups. The primary clinical endpoint was all-cause death, and the safety indicators of mechanical circulatory support included a decrease in hemoglobin greater than 50 g/L, gastrointestinal bleeding, bacteremia, lower extremity ischemia, lower extremity thrombosis, acute kidney injury, pulmonary edema and stroke. Kaplan-Meier survival curves were used to analyze the survival outcomes of patients within 30 days of follow-up. Using VA-ECMO+IABP concurrent group as reference, multivariate Cox regression model was used to evaluate the effect of the combination of VA-ECMO+IABP at different time points on the prognosis of AMICS patients within 30 days. Results: The study included 68 AMICS patients who were supported by VA-ECMO, average age was (59.8±10.8) years, there were 12 female patients (17.6%), 19 cases were in VA-ECMO alone group, 34 cases in VA-ECMO+IABP concurrent group and 15 cases in VA-ECMO+IABP non-concurrent group. The success rate of ECMO weaning in the VA-ECMO+IABP concurrent group was significantly higher than that in the VA-ECMO alone group and the VA-ECMO+IABP non-concurrent group (all P<0.05). Compared with the ECMO+IABP non-concurrent group, the other two groups had shorter ECMO support time, lower rates of acute kidney injury complications (all P<0.05), and lower rates of pulmonary edema complications in the ECMO alone group (P<0.05). In-hospital survival rate was significantly higher in the VA-ECMO+IABP concurrent group (28 patients (82.4%)) than in the VA-ECMO alone group (9 patients) and VA-ECMO+IABP non-concurrent group (7 patients) (all P<0.05). The survival rate up to 30 days of follow-up was also significantly higher surviving patients within were in the ECMO+IABP concurrent group (26 cases) than in VA-ECMO alone group (9 patients) and VA-ECMO+IABP non-concurrent group (4 patients) (all P<0.05). Multivariate Cox regression analysis showed that compared with the concurrent use of VA-ECMO+IABP, the use of VA-ECMO alone and non-concurrent use of VA-ECMO+IABP were associated with increased 30-day mortality in AMICS patients (HR=2.801, P=0.036; HR=2.985, P=0.033, respectively). Conclusions: When VA-ECMO is indicated for AMICS patients, combined use with IABP at the same time can improve the ECMO weaning rate, in-hospital survival and survival at 30 days post discharge, and which does not increase additional complications.
Humans ; Female ; Middle Aged ; Aged ; Shock, Cardiogenic/complications* ; Extracorporeal Membrane Oxygenation/methods* ; Pulmonary Edema/complications* ; Aftercare ; Prospective Studies ; Patient Discharge ; Myocardial Infarction/therapy* ; Intra-Aortic Balloon Pumping/methods* ; Treatment Outcome ; Retrospective Studies

Objective: To investigate the impact of combined use and timing of arterial-venous extracorporeal membrane oxygenation (VA-ECMO) with intra-aortic balloon pump (IABP) on the prognosis of patients with acute myocardial infarction complicated with cardiogenic shock (AMICS). Methods: This was a prospective cohort study, patients with acute myocardial infarction and cardiogenic shock who received VA-ECMO support from the Heart Center of Lanzhou University First Hospital from March 2019 to March 2022 in the registration database of the Chinese Society for Extracorporeal Life Support were enrolled. According to combination with IABP and time point, patients were divided into VA-ECMO alone group, VA-ECMO+IABP concurrent group and VA-ECMO+IABP non-concurrent group. Data from 3 groups of patients were collected, including the demographic characteristics, risk factors, ECG and echocardiographic examination results, critical illness characteristics, coronary intervention results, VA-ECMO related parameters and complications were compared among the three groups. The primary clinical endpoint was all-cause death, and the safety indicators of mechanical circulatory support included a decrease in hemoglobin greater than 50 g/L, gastrointestinal bleeding, bacteremia, lower extremity ischemia, lower extremity thrombosis, acute kidney injury, pulmonary edema and stroke. Kaplan-Meier survival curves were used to analyze the survival outcomes of patients within 30 days of follow-up. Using VA-ECMO+IABP concurrent group as reference, multivariate Cox regression model was used to evaluate the effect of the combination of VA-ECMO+IABP at different time points on the prognosis of AMICS patients within 30 days. Results: The study included 68 AMICS patients who were supported by VA-ECMO, average age was (59.8±10.8) years, there were 12 female patients (17.6%), 19 cases were in VA-ECMO alone group, 34 cases in VA-ECMO+IABP concurrent group and 15 cases in VA-ECMO+IABP non-concurrent group. The success rate of ECMO weaning in the VA-ECMO+IABP concurrent group was significantly higher than that in the VA-ECMO alone group and the VA-ECMO+IABP non-concurrent group (all P<0.05). Compared with the ECMO+IABP non-concurrent group, the other two groups had shorter ECMO support time, lower rates of acute kidney injury complications (all P<0.05), and lower rates of pulmonary edema complications in the ECMO alone group (P<0.05). In-hospital survival rate was significantly higher in the VA-ECMO+IABP concurrent group (28 patients (82.4%)) than in the VA-ECMO alone group (9 patients) and VA-ECMO+IABP non-concurrent group (7 patients) (all P<0.05). The survival rate up to 30 days of follow-up was also significantly higher surviving patients within were in the ECMO+IABP concurrent group (26 cases) than in VA-ECMO alone group (9 patients) and VA-ECMO+IABP non-concurrent group (4 patients) (all P<0.05). Multivariate Cox regression analysis showed that compared with the concurrent use of VA-ECMO+IABP, the use of VA-ECMO alone and non-concurrent use of VA-ECMO+IABP were associated with increased 30-day mortality in AMICS patients (HR=2.801, P=0.036; HR=2.985, P=0.033, respectively). Conclusions: When VA-ECMO is indicated for AMICS patients, combined use with IABP at the same time can improve the ECMO weaning rate, in-hospital survival and survival at 30 days post discharge, and which does not increase additional complications.
Humans ; Female ; Middle Aged ; Aged ; Shock, Cardiogenic/complications* ; Extracorporeal Membrane Oxygenation/methods* ; Pulmonary Edema/complications* ; Aftercare ; Prospective Studies ; Patient Discharge ; Myocardial Infarction/therapy* ; Intra-Aortic Balloon Pumping/methods* ; Treatment Outcome ; Retrospective Studies

BACKGROUND: There are few reports of peri-operative application of intra-aortic balloon pumping (IABP) in patients with coronary artery disease (CAD) and different grades of left ventricular dysfunction. This study aimed to analyze the early outcomes of peri-operative application of IABP in coronary artery bypass grafting (CABG) among patients with CAD and left ventricular dysfunction, and to provide a clinical basis for the peri-operative use of IABP. METHODS: A retrospective analysis of 612 patients who received CABG in the General Hospital of People's Liberation Army between May 1995 and June 2014. Patients were assigned to an IABP or non-IABP group according to their treatments. Logistic regression analysis was performed to investigate the influence of peri-operative IABP implantation on in-hospital mortality. Further subgroup analysis was performed on patients with severe (ejection fraction [EF] ≤ 35%) and mild (EF = 36%-50%) left ventricular dysfunction. RESULTS: Out of 612 included subjects, 78 belonged to the IABP group (12.7%) and 534 to the non-IABP group. Pre-operative left ventricular EF (LVEF) and EuroSCOREII predicted mortality was higher in the IABP group compared with the non-IABP group (P < 0.001 in both cases), yet the two did not differ significantly in terms of post-operative in-hospital mortality (P = 0.833). Regression analysis showed that IABP implantation, recent myocardial infarction, critical status, non-elective operation, and post-operative ventricular fibrillation were risk factors affecting in-hospital mortality (P < 0.01 in all cases). Peri-operative IABP implantation was a protective factor against in-hospital mortality (P = 0.0010). In both the severe and mild left ventricular dysfunction subgroups, peri-operative IABP implantation also exerted a protective role against mortality (P = 0.0303 and P = 0.0101, respectively). CONCLUSIONS Peri-operative IABP implantation could reduce the in-hospital mortality and improve the surgical outcomes of patients with CAD with both severe and mild left ventricular dysfunction.
Aged ; Coronary Artery Bypass ; Coronary Artery Disease ; mortality ; surgery ; therapy ; Female ; Hospital Mortality ; Humans ; Intra-Aortic Balloon Pumping ; methods ; Male ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Ventricular Dysfunction, Left ; mortality ; surgery ; therapy ; Ventricular Function, Left ; physiology