Clinical Application Of Intra-Aortic Balloon Pump On Coronary Artery Bypass Grafting Surgery

Background And ObjectiveWith the development of economics and improvement of living standards, the incidence of coronary heart disease is increasing. Coronary artery bypass grafting(CABG) has been an effective treatment for the high risk patients with severe coronary artery disease, especially for those who can not do percutaneous coronary intervention. Because the condition of the patients who will undergo CABG is increasingly aggravated, perioperative mechanical circulatory support will be a life-saving weapon due to their actions of increasing myocardial perfusion and improving cardiac function. Intra-aortic balloon pump (IABP) is the most widely used mechanical circulatory support devices, which is widely used in left ventricular pump failure, cardiogenic shock, refractory unstable angina, acute myocardial infarction, complications of myocardial infarction (ventricular septal perforation and mitral regurgitation and papillary muscle tear), refractory arrhythmia triggered by myocardial ischemia, preoperative myocardial protection in high-risk patients who will undergo cardiac operation or interventional therapy, septic shock, difficulty weaning off in the operation with cardiopulmonary bypass, and when there is an accident in or after coronary artery bypass, valve replacement surgery and interventional procedure. IABP is more effective in the cardiac surgery especially CABG To the patients with severe coronary artery disease, IABP can increase blood flow of coronary artery, improve peripheral circulation, reduce aortic end-diastolic volume and left ventricular afterload, decrease myocardial oxygen consumption, increase myocardial contractility, increase the blood perfusion of important organ,and improve cardiac function. However, because of operating techniques and factors of patients themselves, IABP complication is inevitable, which can increase the hospital stay and mortality if they are severe. Combination of IABP and CABG can significantly increase myocardial blood supply, increase the oxygen supply and reduce oxygen consumption in the high-risk patients, accordingly it promote myocardial recovery and improve cardiovascular prognosis. This article aims to explore the indications, methods, clinical outcomes and prognosis in application of IABP on CABG which can provide reference for further applications in clinical practice.MethodsTo retrospectively review the clinical material, operation methods, results and prognosis for 14 patients who received IABP during the perioperative periods of CABG from August 2008 to December 2009 in our hospital. There are 10 males and 4 females, in whom the youngest is 46 old years while the oldest is 71 (the average is 59.3).There are 7 patients who have hypertension and 3 have diabetes. Preoperative coronary angiography showed that 1 patient has a single obstructive vessel,1 has two, and 12 have three, in whom 5 have left main stenosis. The number of patients who underwent remote cardiac infarction is 3, and the acute is 4. The place and time of IABP application:9 patients were placed IABP immediately after operation,that in the ICU were 2,that in the second surgical exploration were 3.The application time is 10h-96h(the average is 39h).We used Datascope CS100 IABP machine and selected seldinger technique of percutaneous femoral artery puncture in all 14 patients. And we chose the appropriate trigger mode respectively according to their own condition. Then, we analyzed the heart rate, systolic blood pressure, diastolic pressure, mean arterial pressure, central venous pressure, peripheral oxygen saturation, urine output, cardiac index and dopamine dosage before the use of IABP and after 2 hours' application. The clinical results and prognosis were observed.ResultsIn 14 cases of patients with IABP,cardiac function of 12 cases were significantly improved while 2 cases had no obvious improvement; 10 patients discharged from hospital and 4 died, of which 2 patients died of heart failure,2 died of pulmonary infection. All of the 4 patients who received IABP preoperatively were cured and discharged from hospital.10 patients were received IABP passively intraoperatively or postoperatively, of which 4 died. There were no complications occurred in 14 cases.Conclusion1. IABP can increase diastolic blood pressure, increase coronary blood flow, reduce ventricular afterload and improve myocardial ischemia and hypoxia. It is more effective to the high-risk patients with coronary heart disease and that who had low cardiac output syndrome after cardiac surgery.2.We should use IABP preoperatively to the high-risk patients whose cardiac function were poor before operation, and use earlier to the patients who had low cardiac output syndrome in or after operation.3.After the application of IABP we should pay attention to the effect of it or changes of disease, prevent complications, and give it a early detection or effective treatment. In conclusion, it is when we master the operative technique proficiently that we can give a full value of IABP.