Aim
To report our experience of IABP by means of incremental risk factors for adverse outcome and also to investigate the most optimal way of weaning from the IABP.
Material-Methods
Over a 4-year period, 2697 patients underwent cardiac surgery of whom 136 patients required IABP (5.04%). Out of the 136 entries 100 patients were allocated to be weaned, 50 patients by mode (group A) and 50 by augmentation (group B). Thirty-eight patients from the first subgroup and 41 from the second were followed up with the end point being vascular complications.
Results
The data were collected prospectively. Inhospital mortality was 36%. The incremental risk factors for death were: Cross Clamp time>80 min (ODD ratio =4.16, Confidence Interval=1.73−9.98 “CI”) and IABP insertion postoperatively (OR=19.19, CI=3.16−116.47). The incremental risk factors for development of vascular complications were: Poor ejection fraction (EF) — (OR=3.16, CI = 0.87−11.52), and history of Peripheral Vascular Disease (PVD) (OR=4.99, CI=1.32−18.86). A trend towards less vascular complications was observed when weaning via augmentation (OR 0.44, 95% CI 0.17–1.16).
Conclusions
Despite high mortality in this high risk group of low cardiac output patients, IABP support is justifiable. Furthermore, vascular adverse outcome correlates with “weaning from the IABP by mode” especially in patients with poor heart performance and longstanding arteriopathy.