Relationship between myocardial viability and early application of intra-aortic balloon pump after coronary artery bypass grafting
- VernacularTitle:心肌存活与冠状动脉旁路移植术后早期应用主动脉内球囊反搏的关系
- Author:
Lu ZHANG
1
;
Yijin HU
1
;
Jianming LI
2
;
Jiao WANG
2
;
Hongwu WANG
1
Author Information
1. Department of Anesthesiology, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, 300457, P. R. China
2. Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, 300457, P. R. China
- Publication Type:Journal Article
- Keywords:
Coronary artery disease;
coronary artery bypass grafting;
myocardial viability by PET-CT;
intra-aortic balloon pump
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2023;30(03):396-402
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the relationship between myocardial viability in patients with coronary artery disease who underwent elective coronary artery bypass grafting (CABG) and early application of intra-aortic balloon pump (IABP) after coronary revascularization, and to provide relevant clinical reference for the pre-implantation of 16G single-lumen catheter in the femoral artery of high-risk patients to facilitate the addition of IABP after operation. Methods This retrospective study included 521 patients (414 males and 107 females, aged 62.50±8.82 years) who underwent positron emission tomography (PET)-computed tomography (CT) perfusion-metabolism imaging prior to CABG surgery in our institution from December 2015 to August 2020. The myocardial viability information and left ventricular functional parameters were measured, including the proportion of non-viable myocardium (perfusion-metabolic imaging match), hibernating myocardium (perfusion-metabolic imaging mismatch) and dysfunctional myocardium (non-viable+viable myocardium), left ventricular ejection fraction, left ventricular end-diastolic volume and left ventricular end-systolic volume (LVESV). The patients were divided into an IABP group and a non-IABP group according to whether they received IABP treatment after revascularization. The clinical data were reviewed and compared to explore significant impact factors between the two groups. And the multivariate logistic regression analysis was performed to investigate the correlation between preoperative myocardial viability and early use of IABP after CABG. Results In multivariate logistic regression analysis, the amount of non-viable, dysfunctional myocardium and LVESV value were identified as the independent predictors for the probability of IABP use in the initial postoperative period. Receiver operating characteristic analysis showed that 9.5% non-viable myocardium, 19.5% dysfunctional myocardium, and LVESV of 114.5 mL were the optimal cutoff for predicting early IABP implantation during CABG. Conclusion The myocardial survival status displayed by preoperative PET-CT myocardial perfusion-metabolism imaging can predict the possibility of applying IABP in CABG perioperative period. In addition to routine pre-anesthesia assessment, anesthesiologists can conduct risk stratification assessment for patients with CABG according to the results of preoperative myocardial viability imaging, which is of great significance to ensure the perioperative safety of high-risk patients with CABG.
