Objectives: Beneficial effects of preoperative intra-aortic balloonpump (IABP) treatment have been demonstrated, although there seems to be no difference between subgroups receiving IABP at 2, 12 or 24 hours before surgery. We conducted a non experimental, observational, prospective study to determine the optimal timing for preoperative IABP.
Methods: Thirty high risk patients undergoing cardiac surgery and presenting with one or more of the following inclusion criteria: LVEF < 50 %, unstable angina, left main stem stenosis ≥ 70%, critical triple vessel disease or severe mitral insufficiency, over a 3-year-period, entered the study. Patients of group 1 (n=16) had the IABP inserted at time of induction of general anesthesia. When the IABP is inserted more than 12 hours preoperatively, patients entered group 2 (n=14). The time of insertion the IABP was at the discretion of the surgeon but was mainly determined by the haemodynamic status of the patient and the bed capacity on intensive care. Outcome in terms of mortality, complications, inotropic support, intubation time, length of stay and a cost are compared.
Results: In hospital and 90 day-mortality is comparable (6 and 6 % in group 1 and 0 and 21 % in group 2) for both groups. There are no significant differences in postoperative complications, intubation time, and total hospitalization costs. A tendency towards a shorter length of stay on intensive care and total length of stay was noted for patients in group 1 (117 ± 147 hours and 410 ± 190 hours versus 148 ± 149 hours and 500 ± 343 hours).
Conclusions: In haemodynamic stable patients in whom the surgeon considers preoperative IABP therapy – a so called “prophylactic IABP”-, the IABP can be inserted at the induction of general anaesthesia. Patients with unstable angina and haemodynamics can benefit of a longer preoperative IABP support.