• Roberto Lorusso, Sandro Gelsomino, Rocco Carella, Ugolino Livi, Giovanni Mariscalco, Francesco Onorati, Claudio Russo, and Attilio Renzulli.
• Cardiac Surgery Unit, Civic Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy. roberto_lorusso@iol.it
• Eur J Cardiothorac Surg. 2010 Nov 1; 38 (5): 585-91.

ObjectiveThe aim of this multicentre study was to determine whether the prophylactic use of intra-aortic balloon pump (IABP) translates into better early and long-term results in high-risk patients undergoing cardiac surgery.MethodsFrom January 2000 to March 2009, 6121 high-risk patients (EuroSCORE >8), at six different institutions, underwent cardiac surgery. Propensity-score computer matching was performed, based on 10 variables representing patients characteristics and preoperative risk factors to correct for and minimise selection bias (Hosmer-Lemeshow goodness of fit, p=0.3; c=0.94). A total of 956 patients were successfully matched and consisted of 478 pairs either undergoing preoperative IABP (group A) or not receiving IABP preoperatively (group B).ResultsMultivariate logistic regression (odds ratio) revealed that group B had a 64% higher risk of in-hospital mortality (p=0.001), 57% higher risk of 30-day mortality (p=0.003), 45% higher risk of perioperative myocardial infarction (p=0.01), 57% higher risk of postoperative low-output syndrome (p=0.003), 45% higher risk of intensive care unit (ICU) length of stay (p=0.001) and 44% higher risk of hospital length of stay (p=0.001). Patients in group A showed, at follow-up, significant improvements in left ventricular (LV) ejection fraction (p<0.001), wall-motion score index (p<0.001) and LV dimensions (p<0.001). Five- and 8-year survivals did not differ between groups (5-year survival: 91.7 ± 3.1% vs 95 ± 2.1% in groups A and B, respectively, log-rank p=0.34; 8-year survival: 84.3 ± 5.5% vs 85.9 ± 6.1% in groups A and B, respectively, log-rank p=0.2).ConclusionsProphylactic IABP support, in this multicentre experience, was showed to enhance perioperative management and outcome of high-risk cardiac surgery patients.Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

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