• Ke Okonta, M Anbarasu, and K Kanagarajan.
• Department of Cardiac Surgery Institute of Cardiovascular Diseases Madras Medical Mission, Chennai, India.
• J West Afr Coll Surg. 2011 Oct 1;1(4):28-40.

BackgroundThe management of coronary artery bypass graft (CABG) patients, especially in high risk patients ,can be challenging as the postoperative periods may be characterized by a low cardiac output state. Inotropes used in the perioperative periods to increase cardiac output may be detrimental thus making the use of mechanical devices like intra-aortic Balloon pump (IABP) for circulatory assistance desirable.Aims & ObjectivesTo study the use of intra-aortic balloon pump in coronary artery bypass patients in preoperative and post operative settings and factors that affect morbidity and mortality.SettingMadras Medical Mission, Chennai, India.MethodA retrospective study of 3974 consecutive patients who had CABG done between March 2007 and February 2011 with or without additional procedures. One hundred and seven (2.7%) patients had IABP instituted either pre-operatively or postoperatively when it was obvious the patient will need cardiac assistance. The demographic data, clinical features, the indications for insertion, management offered and outcome , the creatinine levels, the duration of intraarortic balloon pump, the intensive care unit(ICU) and Hospital stay were analyzed for means and standard deviations and Pearsons Chi-square test using SPSS 10.0 window soft ware version with significant value of p-value<0.005.ResultThe mean age of all the patients was 59.7 + SD 10.7, 85(79.4%) patients were males,22(20.6%) were females .Out of the 107 patient who had IABP insertion, 59(55.1%) patients had IABP inserted preoperatively and 48(44.9%) postoperatively. The creatinine levels after the insertion of IABP in 68 patients was<1.5mg/dl and in 39 patients was>1.5mg/dl with mortality of 15.0% for the preoperative insertion group versus 29.0% for the postoperative group respectively (p=0.005). The preoperative and postoperative insertion ICU stay were 8.3+4.7 days and 5.7+1.6days respectively (p=0.005) and mortality were16.8% and 27.1 %( p=0.005) respectively.ConclusionEarly institution of intra-aortic balloon pump gives a better outcome even in high risk coronary artery bypass graft patients as it reduces ICU stay and mortality, and elevated post-insertion creatinine levels has been shown to be an indicator of impending mortality and so an early warning for putting in place mitigating protocols.

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