Key result
IABP counterpulsation increased mean venous aortocoronary bypass graft flow from 54±29 to 63±31 mL/min, with greater increases in right versus left coronary territories.
Why the study?
Few studies had examined the hemodynamic effects of IABP circulatory support on venous aortocoronary bypass graft flows in relation to perfusion territory after CABG.
Does intraoperative intraaortic balloon pumping (IABP) support improve venous aortocoronary bypass graft flow in relation to perfusion territory in emergency CABG patients with critically low ejection fraction?
Observational (n=25)
Does intraoperative intraaortic balloon pumping (IABP) support improve venous aortocoronary bypass graft flow in relation to perfusion territory in emergency CABG patients with critically low ejection fraction?
Intraoperative IABP counterpulsation significantly increases venous aortocoronary bypass graft flow by an average of 23% in emergency CABG patients with severely reduced ejection fraction, particularly in grafts supplying the right coronary territory.
Answers are grounded in this paper and cite their sources.
IABP may augment right more than left venous graft flow in low-EF emergency CABG; leaves open outcome impact and requires randomized confirmation.
Objective: Despite the large volume of published work supporting the use of the IABP for circulatory support in patients following CABG, only few studies exist regarding hemodynamic effects of IABP upon CABG graft flows. We performed an evaluation of the effect IABP support on the degree of blood flow increase in venous aortocoronary (A-C) bypass grafts in relation to the perfusion territory. Methods: In twenty five emergency CABG patients (mean age=67±3 years, gender=19 male, EF=32±3%) requiring IABP support intraoperatively, hemodynamic parameters, mean bypass graft flows, pulsatility index (PI) and diastolic filling index (DFI) of 49 A-C grafts were measured using a transit time flowmeter (TTFM). Results: The overall mean A-C graft flow increased from 54±29 to 63±31ml/min ( p <0.0001). The percent increase amounted to 23±19%. The average DFI of all grafts was 70±7% during IABP versus 62±7% without IABP ( p <0.0001). The mean pulsatility index was 2.6±1.1 with IABP and 2.4±0.8 without IABP assistance ( p =n.s.). Among them, the degrees of increase of mean flow and the diastolic filling index were different between grafts anastomosed to left (n=30) versus right coronary arteries (n=19): mean flow 20% (from 48±25 to 55±24 mL/min) versus 27% (from 62±35 to 75±37 mL/min), p <0.0329; diastolic filling index 68±7% versus 72±7%, p =0.1126. Conclusions: IABP counterpulsation significantly improves venous aortocoronary graft flow in patients with critically low EF following CABG by at least 23%. The increase is of greater value in venous grafts supplying the right coronary territories than in grafts anastomosed to the left side.
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Madershahian et al. (2010) conducted an observational in Critically ill emergency CABG patients with low ejection fraction requiring intraoperative IABP support (n=25). Intraaortic balloon pumping (IABP) counterpulsation vs. Without IABP assistance (baseline off-IABP state in the same grafts) was evaluated on Mean venous aortocoronary bypass graft flow (mL/min) (p=<0.0001). IABP counterpulsation increased mean venous aortocoronary bypass graft flow from 54±29 to 63±31 mL/min, with greater increases in right versus left coronary territories.
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