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Elective Use of Intra‐Aortic Balloon Pump During Aortic Valve Replacement in Elderly Patients to Reduce Postoperative Cardiac Complications
Author(s) -
Nakahira Junko,
Sawai Toshiyuki,
Minami Toshiaki
Publication year - 2014
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.12207
Subject(s) - medicine , intra aortic balloon pump , cardiology , aortic valve replacement , odds ratio , stenosis , cardiac surgery , aortic valve stenosis , valve replacement , surgery , intra aortic balloon pumping , myocardial infarction , cardiogenic shock
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.