Evaluation of preoperative intraaortic balloon pumping for high risk off-pump coronary artery bypass grafting

We evaluated the effect of preoperative intraaortic balloon pumping (IABP) support in high risk patients undergoing off-pump coronary artery bypass grafting (OPCAB). Between November 1999 and December 2010, 65 high-risk patients underwent OPCAB with the support of IABP inserted preoperatively. High risks were considered as (1) left main coronary artery stem stenosis > or = 75%, (2) unstable angina requiring intravenous nitrates and heparin, (3) preoperative left ventricular ejection fraction < or = 30%, (4) bilateral carotid artery stenosis > or = 75%. There were no hospital deaths or cerebrovascular complications. During operations, hemodynamics was stable with the support of low dose catecholamines, and no patient needed conversion to on-pump coronary artery bypass grafting. All patients were able to be weaned from IABP within 3 days (mean 5.7 hours) after the operation and were extubated within 4 days (mean 11.5 hours) after the operation. One patient had a peripheral embolism which might be related to insertion of IABP (1.5%). Preoperative IABP in high-risk patients undergoing OPCAB was considered to be useful and safe.     

高危患者主动脉内球囊反搏辅助下不停跳冠脉搭桥体会

目的探讨严重冠状动脉三支血管病变（狭窄〉75％）的高危患者在主动脉内球囊反搏（IABP）辅助下行非体外循环下冠脉搭桥术的安全性。方法回顾2002年1月至2007年12月间27例高危冠心病患者，在IABP支持下行非体外循环下冠脉搭桥术临床资料。结果本组患者冠状动脉造影均提示严重三支血管病变，15例合并左主干病变（狭窄〉75％），均属高危（EuroSeore〉6分），无术中死亡、术后死亡1例，搭桥2～7支、平均（3．2&#177;1．1）支。结论对于冠脉严重三支血管病变高危病例，在预先置入IABP的辅助下可以安全地施行非体外循环下的冠脉搭桥术。     

Elective intraaortic balloon counterpulsation in high-risk off-pump coronary artery bypass grafting

The beneficial effects of intraaortic balloon pump (IABP) in CABG with cardiopulmonary bypass (CPB) have been reported. However, the benefits of insertion of IABP electively in high-risk off-pump coronary artery bypass grafting (OPCAB) have not been established. Six hundred and twenty-five patients who underwent OPCAB form the study group. High-risk patients fulfilling two or more of the following: left main stem stenosis >70%, unstable angina, and poor left ventricular function, who had elective insertion of IABP preoperatively by the open technique (group I; n = 20) were compared with a similar high-risk group that did not (group II; n = 25). There were no significant differences in risk factors between the two groups (Euroscore 5.68). The mean number of grafts was similar. Postoperatively, there were no significant differences in the need for inotropes, duration of ventilation, arrhythmias, cerebrovascular, gastrointestinal, and infective complications (p = NS). There were no IABP-related complications. Acute renal failure requiring hemofiltration was higher in group II (n = 5; p < 0.05). Four patients (16%) in group II required postoperative IABP. Although intensive care stay was longer in group I (27.6 +/- 15.3 vs. 18.6 +/- 9.1 hours; p < 0.05), patients in group I were discharged earlier from hospital. There was no difference in mortality between the two groups (n = 1 in each group). In high-risk patients undergoing OPCAB, routine preoperative insertion of IABP electively reduces the incidence of acute renal failure. In addition it avoids the need for emergency insertion postoperatively and may result in earlier discharge.     

The effect and role of the intraaortic balloon pumping in off-pump coronary artery bypass

Eighty consecutive patients who underwent off-pump coronary artery bypass (OPCAB) were studied. They were divided into group I (n = 10) which received preoperative intraaortic balloon pumping (IABP), and group II (n = 70) which did not receive IABP. The indications for preoperative IABP were severe left main coronary artery disease in 7 patients, severe 3 vessel disease in 3 patients, unstable angina in 5 patients, acute myocardial infarction in 3 patients. There was no operative mortality in both groups. The average number of distal anastomosis 2.7/patients in group I and 3.3/patients in group II. There was no differences in ventilator support time, length of stay in the intensive care unit and morbidity between 2 groups. The average postoperative IABP support time was 5.4 hours. There was no IABP-related complication in group I. IABP was very effective to perform OPCAB surgery safety. Preoperative IABP may be effective modality to support OPCAB surgery not only in emergent case but also in elective case.     

Optimal coronary artery bypass grafting strategy for acute coronary syndrome

Objective

Conventional coronary artery bypass grafting (CABG) using cardiopulmonary bypass and cardiac arrest is associated with higher mortality and morbidity rates in acute coronary syndrome (ACS) patients undergoing surgery. Although off-pump CABG (OPCAB) is beneficial for high-risk patients, its efficacy for ACS is unknown, with on-pump beating CABG an adjunctive method. We investigated the effects of OPCAB and on-pump beating CABG for ACS.

Methods

We evaluated 121 consecutive patients with ACS (91 males, 30 females; mean age 69.5 ± 10.3 years) who underwent CABG since 2000. Seventy-five had unstable angina (UA) and 46 acute myocardial infarction (AMI) [non-ST elevation (NSTEMI): 22, ST elevation (STEMI): 24]. We assessed CABG for acute coronary syndrome under our primary OPCAB strategy, and compared perioperative status between UA and AMI patients.

Results

(1) Sixty-five (87 %) with UA underwent OPCAB, 8 on-pump beating CABG, and 2 conventional CABG. Conversion from OPCAB was seen in 4 patients. In-hospital mortality was 1.3 %. (2) All UA patients who had intra-aortic balloon pumping (IABP) underwent OPCAB. No patients with preoperative IABP experienced conversion from OPCAB. (3) In AMI patients, hospital mortality was higher (8.9 %) and the ratios for OPCAB, on-pump beating CABG, and conventional CABG were 39, 57, and 4 %, respectively. Mortality was exclusively seen in patients with STEMI who underwent conventional CABG.

Conclusions

OPCAB might have beneficial effects for ACS patients with UA, while IABP was found essential for completing OPCAB. In AMI patients, on-pump beating CABG might be reasonable for avoiding conversion from OPCAB and ischemic perfusion injury.     

Evaluation of preoperative intra-aortic balloon pump in coronary patients with severe left ventricular dysfunction undergoing OPCAB surgery: early and mid-term outcomes

Background  

The purpose of the present study was to evaluate the safety and the cost-effectiveness of using preoperative IABP as support compared with postoperative IABP treatment in coronary patients with severe left ventricular dysfunction (SLVD) who is undergoing off-pump coronary artery bypass surgery (OPCAB), including early outcomes, hospital mortality and morbidity, and mid-term follow-up outcomes.     

Intraaortic balloon pump therapy facilitates posterior vessel off-pump coronary artery bypass grafting in high-risk patients

Background. Displacement of the heart to expose posterior vessels during coronary artery bypass grafting (CABG) without cardiopulmonary bypass (off-pump CABG, or OPCAB) may impair cardiac function. We used the intraaortic balloon pump (IABP) preoperatively to reduce operative risk and to facilitate posterior vessel OPCAB in high-risk patients with left main coronary artery disease (> 75% stenosis), intractable resting angina, postinfarction angina, left ventricular dysfunction (ejection fraction < 35%), or unstable angina.

Methods. One hundred and forty-two consecutive patients who underwent multivessel OPCAB including posterior vessel revascularization were studied prospectively. The patients were divided into group I (n = 57), which received preoperative or intraoperative IABP, and group II (n = 85), which did not receive IABP. In group I, there were 34 patients with left main coronary artery disease, 24 patients with intractable resting angina, 8 patients with left ventricular dysfunction, 5 patients with postinfarction angina, and 40 patients with unstable angina. Seven patients received intraoperative IABP support owing to hemodynamic instability during OPCAB.

Results. There was no operative mortality in group I and 1 death in group II. The average number of distal anastomoses was not different between group I and group II (3.4 ± 0.9 versus 3.5 ± 0.9, p = not significant). There were no significant differences in the number of posterior vessel anastomoses per patient. There were no differences in ventilator support time, length of stay in the intensive care unit, hospital stay, and morbidity between the two groups. There was one IABP-related complication in group I.

Conclusions. IABP therapy facilitates posterior vessel OPCAB in high-risk patients, and surgical results are comparable with those in lower-risk patients.     

Aggressive preoperative use of intraaortic balloon pump in elderly patients undergoing coronary artery bypass grafting

BACKGROUND: The use of the intraaortic balloon pump (IABP) in patients undergoing coronary artery bypass grafting has been traditionally associated with a high complication rate and adverse outcomes. However, recent reports show that many of these catastrophic outcomes can be avoided by preoperatively placing the IABP in high-risk patients. To further validate these reports, we defined a set of liberal criteria for preoperative IABP insertion and applied them to a series of elderly patients (70 years or older) undergoing isolated coronary artery bypass grafting. METHODS: Two hundred six consecutive patients who underwent isolated coronary artery bypass grafting with cardiopulmonary bypass were retrospectively reviewed. A rapid recovery protocol emphasizing reduced cardiopulmonary bypass time, an anesthetic protocol for early extubation, perioperative administration of corticosteroids and thyroid hormone, and aggressive diuresis was applied to all patients. Patients who required an urgent operation because of failed percutaneous transluminal coronary angioplasty, a critical left main stenosis (70% or greater), pronounced left ventricular dysfunction (left ventricular ejection fraction 40% or less), or unstable angina refractory to medical therapy or who required an emergency reoperation received preoperative IABP support. RESULTS: The 30-day mortality rate for the entire group was 4.4%. There were 97 patients (47%) who received a preoperative IABP (group II) in comparison with 109 patients (53%) who did not fulfill the preoperative insertion criteria (group I). Patients in group II had a lower left ventricular ejection fraction (mean, 46% versus 59%, p<0.001) and a higher incidence of congestive heart failure (35% versus 17%, p<0.01) and acute myocardial infarction (37% versus 17%, p<0.01) than patients in group I. The average postoperative hospital length of stay for patients in group II was slightly longer than for those in group I (9.0+/-10.5 versus 6.0+/-3.7 days, p<0.01). However, there were no statistically significant differences in complication or mortality rates between the two groups. Only 2 patients (2.2%) had complications related to IABP insertion. Lower extremity ischemia occurred in both patients, and both were treated successfully with thromboembolectomy. CONCLUSIONS: Liberal preoperative insertion of the IABP can be performed safely in high-risk elderly patients undergoing coronary artery bypass grafting, with results comparable to those in lower risk patients.     

The clinical outcome of off-pump coronary artery bypass surgery in the elderly patients

Objective: There has been a body of evidence showing that off-pump coronary artery bypass (OPCAB) may reduce morbidity and mortality in the elderly patients. We reviewed our experience, retrospectively, on elderly patients aged 75 years and older who were operated on using the OPCAB technique. We compared their outcome to a similar group of elderly patients who were operated on using conventional coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) during the same period of time. Methods: Registry data and patients' notes and charts were reviewed for 56 consecutive elderly OPCAB patients (age 78.5±3.5 years) and 87 consecutive CPB patients (age 77.2±2.4 years, P=0.01). Both groups had similar risk factor profiles: Parsonnet score 17.4±4.4 (OPCAB) versus 16.6±5.2 (CPB), P=0.19. We studied in detail their preoperative and postoperative data in order to compare the outcomes of both techniques. Results: The length of stay in the intensive therapy unit (ITU) was 35.4±52.9 h for OPCAB patients and 77.6±144.9 h for CPB patients (P=0.0008). No patient died within 30 days in the OPCAB group, whilst ten (11%) CPB patients (P=0.0066) died within 30 days. The incidence of serious complications (including pulmonary oedema, septicaemia, permanent stroke and renal dysfunction requiring haemofiltration or haemodialysis) was one (2%) in the OPCAB group and 11 (13%) in the CPB group (P=0.028). CPB patients required a significantly higher number ten (12%) of intra-aortic balloon pumps (IABP) inserted compared to only one patient (2%) in the OPCAB group who required IABP insertion (P=0.05). Nine (11%) CPB patients were re-operated on for bleeding compared to no OPCAB patient (0%) needing re-operation, P=0.011. Conclusions: Although the mean age of the OPCAB group was significantly higher than the CPB group, the OPCAB group showed a significant reduction in postoperative serious morbidity, ITU stay and mortality. We believe that such a conclusion may have some effect on the decision-making and cost-effectiveness when performing coronary bypass surgery on the elderly population.     

Off-pump coronary bypass grafting following percutaneous angioplasty and intra-aortic balloon pumping insertion in a patient with severe peripheral vascular disease

We describe our 1st case of off-pump coronary artery bypass grafting following percutaneous angioplasty (PTA) and intra-aortic balloon pumping (IABP) insertion. A 66-year-old man presented with cardiogenic shock due to acute coronary syndrome. He had concomitant peripheral vascular disease (PVD). He underwent coronary artery bypass grafting following PTA and IABP insertion. Even in an emergency case with PVD, PTA and IABP insertion could be an option to facilitate off-pump coronary artery bypass grafting.     

Off-pump coronary artery bypass grafting for patients with cardiogenic shock due to acute myocardial infarction

Off-pump coronary artery bypass (OPCAB) is less invasive, so we have recently been expanding the indication. We performed OPCAB for 3 patients with cardiogenic shock due to acute myocardial infarction (AMI). PATIENTS: All patients were supported hemodynamically by intra-aortic balloon pumping (IABP) prior to surgery. RESULTS: We performed the revascularization of territories for the left anterior descending artery (LAD) and right coronary artery (RCA) in these high risk patients using OPCAB technique to improve the hemodynamic state. In all patients, IABP was removed within 48 hours after surgery and the postoperative course was uneventful. CONCLUSIONS: It seems that OPCAB is a useful and effective procedure for a selected patient even with cardiogenic shock due to AMI.     

Early results and new indication of the off-pump coronary artery bypass (OPCAB)

BACKGROUND: The off-Pump coronary artery bypass (OPCAB) has recently gained popularity. However the safety and feasibility of the procedure has not been fully proven especially for unstable myocardial ischemia. METHODS: Between March 1998 and November 2000, 135 patients with a mean age of 69.7 (41-95) underwent off-pump coronary artery bypass via sternotomy. Eight patients were operated on emergently and 11 were urgently. LV function ranged from 8% to 70%. Eleven patients required preoperative IABP. RESULTS: All procedures were completed without conversion to cardiopulmonary bypass. The mean number of grafts per patient was 2.8 (range, 1 to 6). Cardiac-related hospital mortality was 2.2% (3/135). Angiographic assessment of grafts demonstrated an overall patency of 98.0%, arterial grafts 98.7% and venous grafts 96.6%. In retrospect, these were equivalent results of conventional coronary artery bypass by the same operator. CONCLUSION: OPCAB is safe and feasible even with LV dysfunction or unstable myocardial ischemia.     

Optimal timing of preoperative intraaortic balloon pump support in high-risk coronary patients.

BACKGROUND: Beneficial effects of preoperative intraaortic balloon pump (IABP) treatment, on outcome and cost, in high-risk patients who have coronary artery bypass grafting have been demonstrated. We conducted a prospective, randomized study to determine the optimal timing for preoperative IABP support in a cohort of high-risk patients. METHODS: Sixty consecutive high-risk patients who had coronary artery bypass grafting (presenting with two or more of the following criteria: left ventricular ejection fraction less than 0.30, unstable angina, reoperation, or left main stenosis greater than 70%) entered the study. Thirty patients did not receive preoperative IABP (controls), 30 patients had preoperative IABP therapy starting 2 hours (T2), 12 hours (T12), or 24 hours (T24), by random assignment, before the operation. Fifty patients had preoperative left ventricular ejection fraction mean, less than 0.30 (less than 0.26+/-0.08), (n = 40) unstable angina, 28% (n = 17) left main stenosis, and 32% (n = 19) were reoperations. RESULTS: Cardiopulmonary bypass was shorter in the IABP groups. There was one death in the IABP group and six in the control group. The complication rate for IABP was 8.3% (n = 5) without group differences. Cardiac index was significantly higher postoperatively (p<0.001) in patients with preoperative IABP treatment compared with controls. There were no significant differences between the three IABP subgroups at any time. The incidence of postoperative low cardiac output was significantly lower in the IABP groups (p<0.001). Intubation time, length of stay in the intensive care unit and the hospital was shorter in the IABP groups (p = 0.211, p<0.001, and p = 0.002, respectively). There were no differences between the IABP subgroups in any of the studied variables. CONCLUSIONS: The beneficial effect of preoperative IABP in high-risk patients who have coronary artery bypass grafting was confirmed. There were no differences in outcome between the subgroups; therefore, at 2 hours preoperatively, IABP therapy can be started.     

非体外循环冠状动脉旁路移植术围术期脑钠肽变化特点及其临床意义

目的探讨B型脑钠肽（BNP）在非体外循环冠状动脉旁路移植术（OPCAB）围术期的变化规律,及其对使用主动脉内球囊反搏（IABP）、术后心房颤动、拔除气管内插管时间和住ICU时间的影响。方法回顾性分析2009年9月至2010年3月北京安贞医院连续168例冠心病患者行OPCAB的临床资料,其中男133例,女35例;年龄60.77±9.32岁。于术前、术后即刻、术后第1 d、第2 d和第3 d测定BNP,记录并分析BNP与使用IABP、预后、拔除气管内插管时间和住ICU时间的关系。结果住院死亡2例,分别死于低心排血量综合征、感染和循环衰竭。BNP于手术后即刻开始显著升高,术后第1 d达高峰,然后逐渐下降。术前和术后LVEF〈50%患者的BNP均明显高于LVEF≥50%患者（术后第2 d中位数：2 198.20 pg/ml vs.531.65 pg/ml,P〈0.05）;使用IABP患者BNP术前、术后均明显高于未使用IABP患者（术后第1 d中位数：5 066.75 pg/ml vs.745.20 pg/ml,P〈0.05）,术前BNP预测放置IABP的ROC曲线下面积为0.834;术后有心房颤动患者BNP均明显高于无心房颤动患者（术后第1 d中位数：1 070.60 pg/ml vs.747.80 pg/ml,P〈0.05）。术后BNP与使用IABP（术后第3 d：r=0.437,P〈0.05）、预后（术后第1 d：r=0.224,P〈0.05）、拔除气管内插管时间（术后第3 d：r=0.440,P〈0.05）和住ICU时间（术后第3 d：r=0.477,P〈0.05）均呈正相关。结论 BNP是反映心功能不全的辅助指标之一,术前BNP显著升高是放置IABP、住ICU时间≥3 d的危险因子。     

Predictors of prolonged mechanical ventilation following aorta no-touch off-pump coronary artery bypass surgery.

OBJECTIVE: To identify parameters associated with prolonged mechanical ventilation (PMV) (>48 h) after off-pump coronary artery bypass (OPCAB) in our patient population. MATERIALS AND METHODS: From February 2001 to November 2005, we operated on 1359 patients for isolated coronary revascularization with the pi-circuit technique, consisting of: (1) beating heart, (2) OPCAB, (3) aorta no-touch, (4) use of composite grafts, and (5) arterial revascularization. RESULTS: From the total number of our patients, 1320 patients had been extubated within 48 h postoperatively (Group A) and 39 patients needed PMV (Group B). In our study we have found that PMV were associated with advanced age (64.74+/-9.85 Group A vs 68.43+/-10.03 Group B, p<0.02) as well as higher incidence with octogenarians (4.4% Group A vs 10.2% Group B, p=0.09). Patients with preoperative history of transient ischemic attacks (TIAs) or stroke were more likely to belong to Group B (1.5% Group A vs 7.7% Group B, p<0.02; 2.8% Group A vs 10.3% Group B, p<0.02, respectively). Preoperative intra-aortic balloon pump (IABP) insertion was associated with PMV (1.6% Group A vs 15.4% Group B, p<0.0005). Unexpectedly, neither COPD nor obesity was associated with PMV (4.9% Group A vs 7.7% Group B, p=NS, 21.7% Group A vs 23.1% Group B, p=NS, respectively). CONCLUSION: In this study, PMV following aorta no-touch OPCAB was related to preoperative variables: age, octogenarians, preoperative IABP, TIA, and stroke. There was no relation between PMV and any of the operative data.     

Coronary vasospasm during off-pump coronary artery bypass grafting; report of two cases

Coronary vasospasm is one of the most dangerous and fatal complications of coronary artery bypass grafting (CABG) operation. Our experiences in recent 2 cases happened during off-pump CABG (OPCAB) are presented. Case 1: A 63-year-old male who had 3 vessels disease underwent OPCAB using left internal thoracic artery (LITA) and the radial artery. When the sternotomy was going to be closed, ST elevation of electrocardiogram (ECG) occurred and was followed by ventricular fibrillation. Intra-aortic balloon pumping (IABP) and percutaneous cardiopulmonary support (PCPS) were applied immediately and an additional grafting to first diagonal artery (D 1) was carried out using a saphenous vein. Case 2: A 67-year-old male underwent OPCAB using LITA and the radial artery. ST elevation of ECG suddenly occurred and was followed by complete atrio-ventricular (AV) block when the sternum was closed. IABP and the ventricular pacing were applied immediately. While OPCAB may be less invasive operating method than conventional CABG, we should pay more attention to the coronary vasospasm.     

A case report of emergency off-pump CABG in an aged patient with ACS renewing ventricular fibrillation.

An emergency off-pump coronary artery bypass (OPCAB) was performed successfully in an aged patient with acute coronary syndrome (ACS). The patient, an 80-year-old woman residing in a nursing home, suddenly lost consciousness during lunch. The electrocardiogram (ECG) showed ventricular fibrillation (Vf) but defibrillation successfully recovered the sinus rhythm. The patient was brought to our hospital as an emergency. She underwent emergency cardiac catheterization. Coronary angiography demonstrated severe three vessel disease with left main coronary trunk (LMT) stenosis. Even during intra-aortic balloon pumping (IABP), the hemodynamic state was unstable, with repeated development of ventricular tachycardia and fibrillation. An emergency coronary artery bypass without a cardiopulmonary bypass was performed. Saving her life was of primary importance and revascularization of the left anterior descending artery (LAD) branch, was performed. Thanks to the advances made in various devices, safe and reliable anastomoses have become possible in OPCAB applied to ACS. OPCAB for ACS have become safe and reliable anastomoses following development of various devices. We think that OPCAB is an effective surgical technique for coronary revascularization for emergency or serious cases involving elderly patients.     

Beating heart coronary artery bypass grafting for acute myocardial infarction

We consider that off-pump coronary artery bypass grafting (CABG) [OPCAB], which results in local myocardial ischemia, is more effective for patients with acute myocardial infarction (AMI) than conventional CABG under cardiac arrest with global myocardial ischemia. Twenty-one patients (15 males, 6 females) received OPCAB for AMI, among whom surgery was performed following percutaneous coronary intervention (PCI) failure in 4 and PCI was performed prior to OPCAB in 2, while PCI was not performed in the remaining 15. Preoperatively, 16 patients had intraaortic balloon pumping (IABP), and 4 had IABP and percutaneous cardiopulmonary support (PCPS). The mean interval from onset to surgery was 11.7 (range 3 to 40) hours. In 20 cases, a complete revascularization was performed. The mean number of bypasses was 2.3 and OPCAB was carried out in 14 patients. In 2 cases, OPCAB was converted to on-pump beating CABG for complete revascularization. Fourteen patients (67%), each maintained with preoperative left ventricular ejection fraction (EF), were discharged with an elective bypass. Four patients died after on-pump beating CABG, in whom EF was lower than 10%. In addition, 3 died of low cardiac output syndrome (LOS) under PCPS and 1 of ventricular fibrillation. Based on our results, we considered that complete revascularization using OPCAB was effective for cases of AMI with PCI difficulty. However, in shock cases requiring PCPS, cardiac function was not improved even after revascularization. Therefore, it is necessary to study new procedures for shock cases during the period from onset to surgery.     

Elective intraaortic balloon counterpulsation for high-risk off-pump coronary artery bypass operations

BACKGROUND: Dislocations of the heart required for exposure and construction of distal anastomoses often produce hemodynamic instability when performing coronary artery revascularization without using cardiopulmonary perfusion (OPCAB). We report our early experience with elective intraaortic balloon counterpulsation (IABP) to enable and facilitate selected high-risk patients to undergo OPCAB. METHODS: Sixteen high-risk patients undergoing multivessel OPCAB using elective IABP are reported. The patients were believed to be at increased risk because of the presence of severe proximal multivessel coronary artery obstruction, ventricular dysfunction, recent acute myocardial infarction, cardiomegaly-cardiomyopathy, and documented cerebral vascular disease. The presence of significant comorbid disease also made the avoidance of cardiopulmonary bypass desirable, if at all possible, in all patients. RESULTS: The IABP appeared to facilitate the intraoperative management of our series of patients. This was evidenced by improved hemodynamic stability and virtual elimination of the need for inotropic support during the dislocations of the heart needed for exposure and construction of distal anastomoses. There were no complications related to use of IABP. There was one death. CONCLUSIONS: We believe this strategy to use IABP selectively can allow surgeons to safely extend the benefits of OPCAB procedures to high-risk patients and avoid dangerous hemodynamic instability that otherwise, often occurs.     

New method for accurate ECG trigger of intraaortic balloon counterpulsation during off-pump coronary artery bypass surgery

BACKGROUND: Retractions of the heart required for exposure and construction of distal anastomoses often decrease R-wave amplitude of ECG and interfere with intraaortic balloon pump (IABP) trigger during off-pump coronary artery bypass (OPCAB). Missing R wave trigger results in asynchronous work of IABP and probably produces hemodynamic instability. We report our early experience with a new interface BPI 202 (Osypka Medical, Inc., USA) for sensing accurate ECG trigger for IABP during OPCAB procedure. CASES: Six high-risk patients undergoing multivessel OPCAB using BPI 202 are described. RESULTS: With the new interface BPI 202, simulated R wave signal could be processed from an external dual chamber pacemaker sensing surface R wave. The simulated R wave was successfully used for controlling IABP and secured a synchronous work between the heart and IABP during heart retraction maneuver. BPI 202, an interface for IABP appeared to facilitate the intraoperative management of our series of patients. CONCLUSIONS: We believe BPI 202 can produce a synchronous work of IABP during OPCAB procedures to high-risk patients and avoid dangerous hemodynamic instability.