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J Thorac Cardiovasc Surg 2000;120:1112-1119
© 2000 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Prophylactic value of preincision intra-aortic balloon pump: Analysis of a statewide experience

From the Departments of Surgery,^a Medicine,^b and Anesthesiology,^c University of Alabama at Birmingham, Birmingham; Department of Medicine,^d Duke University Medical Center, Durham, NC; Alabama Quality Assurance Foundation,^e Birmingham; and Birmingham Veterans Affairs Medical Center,^f Birmingham, Ala.

Address for reprints: William L. Holman, MD, Department of Surgery, 703 South 19th St, University of Alabama at Birmingham, Birmingham, AL 35294-0007 (E-mail: wholman{at}its.uab.edu).

Objective: The objective of this study was to determine whether preincision use of an intra-aortic balloon pump improves survival and shortens postoperative length of stay in hemodynamically stable, high-risk patients undergoing coronary artery bypass grafting.
Methods: A post hoc analysis of the Alabama CABG Cooperative Project database was performed by using propensity scores to model the likelihood of receiving a prophylactic preincision intra-aortic balloon pump. Every patient receiving a prophylactic preincision balloon pump was matched with another patient of similar propensity score who did not receive one. We then compared outcomes for matched pairs.
Results: There were 7581 patients of whom 592 received a prophylactic preincision balloon pump. Patients with preoperative renal insufficiency, heart failure, or left main coronary artery disease, or who had undergone previous bypass grafting were significantly more likely to receive a prophylactic preincision balloon pump. By using propensity scores, we matched 550 patients who received a prophylactic preincision balloon pump with 550 who did not. Survival did not significantly differ by whether a prophylactic preincision balloon pump was used. However, surviving patients who received a preincision balloon pump had a significantly shorter postbypass length of stay (7 ± 7.3 days) than did matched patients not receiving a balloon pump (8 ± 6.2 days; P < .05).
Conclusions: No survival advantage was found for use of a prophylactic intra-aortic balloon pump in hemodynamically stable, high-risk patients undergoing bypass grafting, as opposed to placing a balloon pump on an "as needed" basis during or after the operation. However, the patients receiving the balloon pump had improved convalescence as shown by significantly shorter length of stay.

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