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Ann Thorac Surg 2001;71:1400-1401
© 2001 The Society of Thoracic Surgeons

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Correspondence

Preoperative intraaortic balloon pump in high-risk patients: Reply

^a Clinic for Cardiovascular Surgery, University Hospital, 24 rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland

e-mail: Jan.Christenson{at}hcge.ch

To the Editor

I have with great interest read the comments by Dr Baskett and his colleagues regarding my article [1]. It is absolutely correct, as stated by Dr Baskett, that we have demonstrated, in a prospective randomized trial, a significantly higher hospital mortality rate in patients who did not receive preoperative intraaortic balloon pump (IABC) therapy (control group) compared to similar high-risk patients who received preoperative IABC therapy [2]. It should, however, be noted that at the time there were no other studies published that could confirm these results. Because of lack of supportive studies from other institutions together with a rather small number of control patients used in the first trial (n = 30) and the need to evaluate optimal timing for the preoperative IABC therapy, it was decided to perform a second prospective randomized trial including a control group (patients not receiving preoperative IABC therapy). This issue was thoroughly discussed by the local Ethical Committee, which granted permission for the trial, and second trial was undertaken [3]. Based on the experience from the first trial, the cut-off level for preoperative LVEF was lowered from less than 0.40 to less than 0.30. Since at least two high-risk criteria were requested for inclusion in both studies there were no fundamental differences between patients used for the combined study on the economical impact of preoperative IABC therapy that would have any impact of the analysis done [1]. In conclusion, the combined study did not only demonstrate a highly significant decrease in hospital mortality when preoperative IABC therapy was used, but also decreased postoperative morbidity as well as a significantly shortened ICU and hospital stay, and a significant difference in procedural cost [1]. Further use of a control group in this context (high-risk coronary patients) is therefore no longer acceptable.

References

1. Christenson J.T., Simonet F., Schmuziger M. Economic impact of preoperative intraaortic balloon pump therapy in high-risk coronary patients. Ann Thorac Surg 2000;70:510-515.[Abstract/Free Full Text]
2. Christenson J.T., Simonet F., Badel P., Schmuziger M. Evaluation of preoperative intra-aortic balloon pump support in high-risk coronary patients. Eur J Cardiothorac Surg 1997;11:1097-1103.[Abstract]
3. Christenson J.T., Simonet F., Badel P., Schmuziger M. Optimal timing of preoperative intraaortic balloon pump support in high-risk coronary patients. Ann Thorac Surg 1999;68:934-939.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Jan T. Christenson Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Christenson, J. T. Search for Related Content PubMed Articles by Christenson, J. T. Related Collections Mechanical Circulatory Assistance Related Article