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Ann Thorac Surg 2002;74:1086-1090
© 2002 The Society of Thoracic Surgeons
a Department of Cardiovascular Surgery, University Hospital, Geneva, Switzerland
b Hahnemann Medical Center, Philadelphia, Pennsylvania, USA
c Texas Heart Institute, Houston, Texas, USA
d Tulane Medical Center, New Orleans, Louisiana, USA
e M. F. Miller Statistical Services, Langhorne, Pennsylvania, USA
f University of North Carolina, Chapel Hill, North Carolina, USA
g State University of New York Health Center, Brooklyn, New York, USA
h The Cardiovascular Research Foundation, New York, New York, USA
i Hôpital de la Tour, Geneva, Switzerland
Accepted for publication June 5, 2002.
* Address reprint requests to Dr Christenson, Clinic for Cardiovascular Surgery, University Hospital, 24 rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland
e-mail: jtchristenson{at}hotmail.com
Background. As the proportion of high-risk patients for cardiac surgery increases, use of intraaortic balloon counterpulsation (IABC) has increased, especially in preoperative therapy. Although the efficacy and cost-effectiveness of IABC have been demonstrated, historically higher complication rates have dissuaded some practitioners from using IABC.
Methods. This report describes IABC use in cardiac surgery, examines trends in complications over time, and compares outcomes in preoperative versus postoperative use in a single prospective worldwide registry over the past 3 years.
Results. The frequency of IABC use appears to be increasing with time as the complication rates have dramatically fallen. The overall IABC-related complication rate was 6.5% (460/7,101), and the rate of major complications (requiring surgery or transfusion) was 2.1% (148/7,101). Hospital mortality was significantly lower in patients treated preoperatively with IABC compared with patients treated postoperatively (8.8% vs 28.2%, p < 0.0001), although this may be due to a selection bias in the postoperative group.
Conclusions. Preoperative IABC therapy leads to better patient outcomes in high-risk CABG patients. Improved IABC technology and better surveillance have led to increased use with lower complication rates. Although selection bias is inherent in retrospective studies, the Benchmark Counterpulsation Outcomes Registry outcomes are in close concordance to prospective randomized studies previously reported.
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