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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2002 February;43(1):17-23

lingua: Inglese

Mortality and morbidity from intra-aortic balloon pumps. Risk analysis

Meco M., Gramegna G., Yassini A., Bellisario A., Mazzaro E., Babbini M. *, Pediglieri A. *, Panisi P., Tarelli G., Frigiola A. **, Menicanti L. **, Cirri S.

From the Division of Cardiac Surgery
*Division of Anesthesia and Resuscitation
**Division of Cardiac Surgery
Malan Center S. Ambrogio Clinical Institute, Milan, Italy
San Donato Hospital San Donato Milanese - Milan, Italy


Background. The pur­pose of ­this ­study, was to ­assess the inci­dence of and pre­dic­tors for mor­tal­ity and mor­bid­ity in ­patients who ­required post­op­er­a­tive intra-­aor­tic bal­loon ­pump (­IABP) sup­port.
Methods. We ­have ret­ro­spec­tive­ly esti­mat­ed 116 ­patients and ­data ­were sta­tis­ti­cal­ly ana­lyzed, and sig­nif­i­cant var­i­ables ­were eval­u­at­ed ­with mul­ti­var­i­ate anal­y­sis.
Results. Mortality ­rate was 57.8% (67 ­patients). Nineteen ­patients (16.3%) had ­major vas­cu­lar com­pli­ca­tions: 12 ­patients (10.3%) ­limb ische­mia, 1 ­patient (0.9%) aor­tic dis­sec­tion, 6 ­patients (5.2%) mes­en­ter­ic infarc­tion. Thirty ­patients (25.8%) had ­minor vas­cu­lar com­pli­ca­tion: 23 ­patients (19.8%) bleed­ing ­from inser­tion ­site, 7 (6%) ­patients infec­tion of inser­tion ­site. Limb ische­mia was ­resolved by ­IABP remov­al (10 ­patients), throm­bec­to­my (2 ­patients). No ­patient ­required ­limb ampu­ta­tion. Sixty ­patients (51.7%) had ­renal insuf­fi­cien­cy, of ­which 40 ­patients need­ed dial­y­sis. Fifteen ­patients (10.3%) had neu­ro­log­i­cal com­pli­ca­tions, 13 ­patients (11.2%) throm­bo­cy­to­pe­nia and 5 ­patients (4.3%) sep­sis.
Conclusions. The inci­dence of ­IABP inser­tion in our insti­tu­tion was 1.5%. Mortality ­rate is sim­i­lar to mor­tal­ity of oth­er stud­ies in ­which the ­IABP has ­been insert­ed in the ­postoper­a­tive peri­od. We ­have ­found ­that tim­ing of ­IABP inser­tion, throm­bo­cy­to­pe­nia, pres­ence of periph­er­al vas­cu­lar dis­ease and the ­redo inter­ven­tion are inde­pen­dent pre­dic­tors of mor­tal­ity. We ­also ­found ­that ­female sex, dia­betes, his­to­ry of cig­ar­ette smok­ing and pre­op­er­a­tive use of anti­plate­let ­drugs are inde­pen­dent pre­dic­tors of ­limb ische­mia. The fol­low­ing fac­tors are ­instead inde­pen­dent pre­dic­tors of ­renal insuf­fi­cien­cy: post­op­er­a­tive ejec­tion frac­tion low­er ­than 40% and non use of dobu­ta­mine in the post­op­er­a­tive peri­od.

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