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Ann Thorac Surg 1999;68:1438-1439
© 1999 The Society of Thoracic Surgeons

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Correspondence

Reply

^a Departments of Medicine and Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada

e-mail: wghali{at}acs.ucalgary.ca

To the Editor

We congratulate Christenson and colleagues for their important clinical trials [1, 2] evaluating preoperative use of the intraaortic balloon pump (IABP). These are significant contributions to the cardiac surgery literature that certainly address our recent call [3] for randomized controlled trials of the IABP. It is worth mentioning in passing that before the publication of our paper on variation in hospital rates of IABP use [3], some formal and informal reviewers of our manuscript felt that our call for randomized controlled trials in this area was unrealistic and impractical. We nonetheless felt strongly about this call, and are delighted to see the work of Christenson and colleagues.

The trials by Christenson and colleagues suggest that hospitals with a higher rate of IABP may be using this technology more "optimally." However, it is difficult to make this assertion confidently from our data, because we were unable to determine (in our administrative database) whether IABP use began pre, intra, or postoperatively. We were also, of course, unable to determine the appropriateness of IABP use in Massachusetts hospitals relative to the definitions of "high risk" provided by Christenson and colleagues. We assert that there is now, more than ever, a need for health services studies evaluating the appropriateness and effectiveness of IABP use in the "real world," because we now have prospective clinical trial data suggesting its efficacy for high-risk patients within the controlled environment of small clinical trials, where complication rates were very low.

We are encouraged by Dr Christenson’s suggestion that IABP complication rates can potentially be reduced by the use of small-diameter catheters and more rigorous surveillance, and look forward to future publications exploring and/or describing these preventive strategies.

References

1. Christenson J.T., Badel P., Simonet F., Schmuziger M. Preoperative intraaortic balloon pump enhances cardiac performance and improves the outcome of redo CABG. Ann Thorac Surg 1997;64:1237-1244.[Abstract/Free Full Text]
2. Christenson J.T., Simonet F., Badel P., Schmuziger M. Evaluation of preoperative intraaortic balloon pump support in high-risk coronary patients. Eur J Cardiothoracic Surg 1997;11:1097-1103.[Abstract]
3. Ghali W.A., Ash A.S., Hall R.E., Moskowitz M.A. Variation in hospital rates of intraaortic balloon pump use in coronary artery bypass operations. Ann Thorac Surg 1999;67:441-445.[Abstract/Free Full Text]

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