Original research

DOI: http://doi.org/10.31928/2305-3127-2019.2.2230 

Risk factors for postoperative mortality with intra-aortic balloon counterpulsation in the early period after coronary artery bypass surgery in elderly and geriatric patients

O.M. Druzhyna ^{1, 2}, O.A. Loskutov ^{1, 2}, S.R. Maruniak ^{1, 2}, A.V. Mykhailova ¹

¹ Heart Institute, Ministry of Health of Ukraine, Kyiv, Ukraine

² Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine

The aim – to determine the risk factors of postoperative mortality during intra-aortic balloon counterpulsation (IABC) in the early period after coronary artery bypass surgery(CABG) in elderly and geriatricpatients.

Materials and methods. During the course of the study, 320 CABG procedures with cardiopulmonary bypass (CPB) were performed, among them 13 (4.06 %) patients required weaning from CPB by using intra-aortic balloon counterpulsation, with one patient additionally requiring the use of extracorporeal membrane oxygenation. Among 12 patients requiring only IABC, 7 (58.33 %) patients (survivors group) survived and 5 (41.67 %) died (mortality group) died. We used the method of echocardiography to evaluate the hemodynamic indices.

Results. Patients who died had reliably lower ejection fraction by 19.08 % (p = 0.045) compared to those who survived. Also, the surgical intervention in patients who died was characterized by a significantly longer period of CPB and aortic crossclamping (p = 0.032 and p = 0.041, respectively). After 24 hours of the IABC, survivors showed a significantly higher CI level by 15.6 % (p = 0.049) compared to a group of patients who died in the early postoperative period. Patients surviving after IABC showed a tendency to decrease of the CVP, while in patients who died, on the contrary, there was a tendency to increase of this parameter.

Conclusions. Relevant risk factors for postoperative mortality in the use of IABC in patients after CABG were left ventricular ejection fractions < 40 % (p = 0.035, OR = 3.81), duration of CPB > 120 min (p = 0.048, OR = 2.41) and the duration of aorta crossclamping > 60 min (p = 0.047, OR = 2.19).

Key words: coronary artery bypass surgery, intra-aortic balloon counterpulsation, post-cardiotomy myocardial dysfunction.