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Ann Thorac Surg 2007;84:498-502
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Reduced Mortality in High-Risk Coronary Patients Operated Off Pump With Preoperative Intraaortic Balloon Counterpulsation

^a Department of Cardiac Surgery and Cardiology, Clinique Saint Luc, Brussels, Belgium
^b Cliniques Universitaires Saint Luc, Brussels, Belgium

Accepted for publication March 26, 2007.

^_* Address correspondence to Dr Etienne, Department of Cardiac Surgery, Clinique Saint Luc, Bouge, Brussels, 5004, Belgium (Email: pierre.yves.etienne{at}skynet.be).

Background: Preoperative intraaortic balloon pump (IABP) counterpulsation has better outcomes compared with perioperative or postoperative insertion in critical patients, and off-pump surgical procedures have been advocated to reduce mortality in high-risk patients. However, some surgeons are reluctant to perform beating heart operations in specific patient subgroups, including those with unstable angina or patients with low ejection fraction, because of their possible perioperative hemodynamic instability.

Methods: We evaluated combined beating heart procedures and preoperative IABP in selected high-risk patients and compared our results with the predictive European System for Cardiac Operative Risk Evaluation (EuroSCORE) model. Fifty-five high-risk patients with a mean logistic EuroSCORE of 24 were prospectively enrolled and then divided into emergency (group 1, n = 25) and nonemergency (group 2, n = 30) groups. IABP was inserted immediately before operation in group 1 and the day before the procedure in group 2.

Results: Compared with the EuroSCORE predictive model, a dramatic decrease in mortality occurred in both groups. Group I predicted mortality was 36.8%, and observed was 20%; and group 2 predicted mortality was 15.2% and observed was 0%. No specific complications from the use of IABP were encountered. During mid-term (2 years) follow-up, no patient died from a cardiac cause or required percutaneous coronary intervention or subsequent reoperation due to incomplete revascularization.

Conclusions: The combined use of preoperative intraaortic counterpulsation and beating heart intervention allows complete revascularization in high-risk patients with a important reduction in operative mortality and excellent mid-term results.

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Invited commentary

Jan T. Christenson
Ann. Thorac. Surg. 2007 84: 502-503. [Extract] [Full Text] [PDF]

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				J. T. Christenson Invited commentary Ann. Thorac. Surg., August 1, 2007; 84(2): 502 - 503. [Full Text] [PDF]