Læknablaðið - feb. 2020, Síða 18

70 LÆKNAblaðið 2020/106

Introduction: Intra-aortic balloon pump (IABP) is a mechanical
device that increases cardiac output by increasing diastolic blood
flow to the coronary arteries and lowers the afterload of the left
ventricle in systole. IABP is primarily used in acute heart failure,
that includes patients that have to undergo coronary artery bypass
grafting (CABG). Its usage, however, in cardiac surgery has been
declining with ongoing controversy regarding its benefits. The aim
of this study was to assess the use and indications and outcome of
IABP related to CABG surgery.
Material and Methods: The study was retrospective and included
2177 patients that underwent CABG at Landspítali during 2001-
2018. We compared those who received an IABP with controls,
using uni- and multivariate analysis. Long term survival and
complications (major adverse cardiovascular and cerebral events,
MACCE) was estimated with Kaplan-Meier method.
Results: A total of 99 (4.5%) patients received an IABP. The
incidence was highest in 2006 (8.9%) and lowest in 2001 (1.7%), but
the incidence did not change during the study period (p=0.90). Most
patients received the pump before (58.6%) or during (34.3%) CABG,
but only 6.1% after surgery. Complication rate was 14.1%, with
bleeding from the insertion site in the groin being the most common
complication. Thirty day mortality was higher in the IABP group
compared with controls (22.2% vs 1.3%, p<0.001) and both 5-year
survival (56.4% vs 91.5%, 95% CI: 0.47-0.67) and 5-year MACCE-
-free survival (46.9% vs 83.0%, 95% CI: 0.38-0.58) were inferior.
Conclusions: Less than 5% of patients received IABP in relation to
CABG in Iceland and the rate hasn’t changed much for the last 18
years. Both the complication rate and 30-day mortality was higher
in patients in IABP group and both the long term and MACCE-free
survival was much worse, probably mostly related to worse overall
clinical condition of the patient that received IABP.
The use of Intra Aortic Balloon Pump in Coronary Artery Bypass Graft Surgery
ENGLISH SUMMARY
1Faculty of Medicine, University of Iceland, 2Department of Anesthesia and Intensive Care, Akademiska University Hospital, Uppsala, Sweden, 3Departments of Anesthesia
and Intensive Care, 4Cardiothoracic surgery, Landspitali University Hospital, Reykjavik, Iceland.
Key words: Intra-aortic balloon pump, coronary artery bypass graft (CABG), indications, complications, outcome, survival.
Correspondence: Tómas Guðbjartsson, tomasgudbjartsson@hotmail.com
Sunna Lu Xi Gunnarsdóttir1
Erla Liu Ting Gunnarsdóttir1
Alexandra Aldís Heimisdóttir1
Sunna Rún Heiðarsdóttir1
Sólveig Helgadóttir2
Martin Ingi Sigurðsson1,3
Tómas Guðbjartsson1,4
DOI: 10.17992/lbl.2020.02.372
R A N N S Ó K N