RISK FACTORS AND OUTCOM OF INTRA-AORTIC BALLON PUMP APPLICATION IN CARDIAC SURGERY Mottahedi B MD, Dept. of Cardiovascular Surgery Ghaem Hospital Mashhad University of Medical Sciences Mashhad,, IRAN

Intra-Aortic Balloon Pump (IABP) 2

برخی اندیکاسیون ها : 1- شوک کاردیوژنیک 2- سندروم LCO پس از کاردیوتومی 3- آریتمی مقاوم به درمان 4- پس از شکست PTCA 5- MR حاد یا VSD پس از MI 6- در جراحی عمومی 3

Background  IABPs are used as an adjunct to pharmacologic therapies in end stage cardiac failure conditions or in the peri-operative heart surgeries.  Predominant action: - Myocardial oxygen / demand improvement - Reduce LV afterload  Remains to be established - Outcome - Determination of risk factors affecting outcome Specially in regions from which there is still no data presented in the medical literature. 4

Literature Review  Used in cardiac surgery since late 1960s  Now: Most commonly used assist device in cardiac surgery  2-6% have postcardiotomy LCO  70-90% success to wean from CPB  60-70% explantation rate of IABP  33-70% survive 30 days 5

RISK STRATIFICATION OUTCOME RISK FACTORS SCORING RISK FACTORS (PREDICTIVITY) RISK STRATIFICATION MODEL NO USE OF IABP ???? OTHER SUPPORT DEVICES BE INSTITUTED IN A TIMELY MANNER 6

GOAL TO EVALUATE: 1) Outcome 2) Risk factors In as much more patients as possible, in the Iranian patient population 7

Patients  All patients with IABP (all DATASCOPE)  Two major tertiary teaching hospitals Ghaem Hospital(Mashhad)-Modares Hospital(Tehran)  Duration of study; five years  Retrospective study  Data evaluated: - Mortality - Common risk factors affecting outcome 8

Results 1  238 patients  4.4% of all CPB patients  95% was to wean from CPB  59% able to explant IABP - 4.2% of all died later in hospital % of all were discharged 9

 Survival rate = 54.8%  increased mortality - Female sex (p<0.05) - Hypertension (p<0.05) - Extended CPB time (p<0.01) Results 2 10

NO RISK FACTORS NO STATISTICAL DIFERENCE IN OUTCOME  Age, Weight, BSA  DM, HLD, C/S  EF  LV Aneurysm  Emergency Surgery  # of Grafts  CABG +/- Valve  LIMA (Yes / No)  Redo (Yes / No)  U/A (Yes / No)  LM Dx (Yes / No)  Catastrophic States  AXCT  Different Hospital  Different surgeon 11

All / IABP Risk Factors Risk FactorsAll PatientsIABP Patients AgeP = 0.019NS SexP <0.05 DiabetesNS HTNP = 0.05P <0.05 Emerg SurgP < NS Low EFP = 0.04NS LV AneurysmP < 0.001NS CPB Time *P < P <0.01 Hassantash et al. Asian Cardiovasc Thoracic Ann 2004:12 12

Conclusion  IABP helps more than half of our patients who would otherwise not survive  Altered patient’s physiopathologic condition of body’s systems, secondary to IABP application, may offset the effects of most known adult cardiac surgery risk factors in this subgroup 13

Suggestion Studies including more patients may better define the results of IABP use and also provide a risk stratification model according to predictive risk factors defined by multivariate analyses 14

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