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Ann Thorac Surg 2002;73:1026-1027
© 2002 The Society of Thoracic Surgeons

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Correspondence

Preoperative IABP in high-risk patients reduces postoperative lactate release and subsequent mortality

^a Clinic for Cardiovascular Surgery, University Hospital, 24 rue Micheli-du-Crest, CH-1211 Geneva 24, Switzerland
^b Division of Cardiology, MS-119, Hahnemann University Hospital, Broad and Vine Sts, Philadelphia, PA 19102, USA

e-mail: jtchristenson{at}hotmail.com
e-mail: marc.cohen{at}tenethealth.com

To the Editor

In an article by Davies and associates, recently published in The Annals [1], it was reported, from a retrospective analysis of 39 patients requiring intraaortic balloon pump (IABP) support after cardiac surgery, and employing univariate analysis, that persistent high lactate predicts failure of intraaortic balloon pumping. However, cardioplegic arrest induces anaerobic myocardial metabolism which leads to a net production of lactate from glycolysis, and persistant lactate is an independent predictor of postoperative low cardiac output due to a delayed recovery of aerobic myocardial metabolism [2]. To overcome postoperative low cardiac output inotrope support, often IABP is required. Since delay in recovery of aerobic myocardial metabolism has nothing to do with IABP per se, we have some difficulties in understanding this relationship claimed by the authors.

Preoperative IABP therapy in high-risk patients alleviates myocardial ischemia prior to circulatory arrest and paves the way for quick postoperative recovery to normal metabolism and less lactate formation [3–4]. It was therefore interesting to notice in Davies and coworkers’ article that 7 of 10 patients who received preoperative IABP survived compared to 37% when IABP was initiated intra- or postoperative. These results do correspond better with the more modern literature on IABP therapy [5–6]. The authors have not separated out pre-, intra-, and postoperative balloon insertions to derive their conclusion. They refer to very old literature when they discuss their very high complication rates [1]. Overall IABP-related complications in 1,119 patients treated with IABP was reported to be 15%, and major complications occurred in only 4.1% [7]. The authors should restate their conclusion as "preoperative IABP in high-risk patients reduces postoperative lactate release and subsequent mortality."

References

1. Davies A.R., Bellomo R., Raman J.S., Gutteridge G.A., Buxton B.F. High lactate predicts the failure of intraaortic balloon pumping after cardiac surgery. Ann Thorac Surg 2001;71:1415-1420.[Abstract/Free Full Text]
2. Rao V., Ivanov J., Weisel R.D., Cohen G., Borger A., Mickle D.A.G. Lactate release during reperfusion predicts low cardiac output syndrome after coronary bypass surgery. Ann Thorac Surg 2001;71:1925-1930.[Abstract/Free Full Text]
3. 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]
4. Gutfinger D.E., Ott R.A., Miller M., et al. Aggressive preoperative use of intraaortic balloon pump in elderly patients undergoing coronary artery bypass grafting. Ann Thorac Surg 1999;67:610-613.[Abstract/Free Full Text]
5. Christenson J.T., Simonet F., Schmuziger M. Economical impact of preoperative intra-aortic balloon pump therapy in high-risk coronary patients. Ann Thorac Surg 2000;70:510-515.[Abstract/Free Full Text]
6. Holman W.L., Li Q., Kiefe C.I., McGriffin D.C., Peterson E.D., Allman R.M., Nielsen V.G., Pacifico A.D. Prophylactic value of preincision intra-aortic balloon pump: analysis of a statewide experience. J Thorac Cardiovasc Surg 2000;120:1112-1119.[Abstract/Free Full Text]
7. Cohen M., Dawson M.S., Kopistansky C., McBride R. Sex and other predictors of intra-aortic balloon counterpulsation—related complications: prospective study of 1119 consecutive patients. Am Heart J 2000;139:282-287.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed 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. Articles by Cohen, M. Search for Related Content PubMed PubMed Citation Articles by Christenson, J. T. Articles by Cohen, M. Related Collections Mechanical Circulatory Assistance Related Article