Liberal use of intra-aortic balloon pumping in patients undergoing coronary bypass surgery

The intra-aortic balloon pump (IABP) is an effective, minimally invasive cardiac assist device which can be used perioperatively to increase survival after cardiac surgery. Surgeons vary according to how aggressively they use IABP. Some prefer to use increased doses of inotropic drugs in the first instance. From August 1990 to February 1993, 38 of 480 consecutive patients having cardiac surgery for ischaemic heart disease (IHD) had perioperative insertion of the IABP (usage rate 7.9%). There was a low threshold for its use, with some IABPs being placed in patients prophylactically in the operating theatre if postoperative low cardiac output was anticipated. Generally, if inotropic medication was required (greater than renal dosage dopamine) when the patient left the operating theatre, the IABP was inserted, and an attempt made to minimise inotropic medication. The IABP was more commonly inserted for complex coronary cases (40% of 55 patients) than when a primary coronary artery bypass graft (CABG) was performed (3.8% of 425 patients). The early mortality overall was 1 % and in the IABP group was 5.3%. There were 2 late deaths. IABP-related morbidity was infrequent (one false aneurysm of femoral artery requiring repair, one burst balloon requiring open removal via a groin incision). Complications were more commonly patient related. Using this approach, the mortality was 3.6% for complex coronary surgery and 0.7% for first time CABG. Inotropic medication was required in only 10% of patients, and in 68% of these, low dosage only was necessary.