Role of Intra-Aortic Balloon Pump in Off-Pump Coronary Artery Bypass —A Vettath Modification

作     者：Murali P. Vettath Kannan A. Vellachamy Nitin Gangadharan Sanooj Ottuparakuzhiyil Jayaprakash Moothencherie Murali P. Vettath;Kannan A. Vellachamy;Nitin Gangadharan;Sanooj Ottuparakuzhiyil;Jayaprakash Moothencherie

作者机构：Department of Cardiac Surgery Malabar Institute of Medical Sciences Kozhikode Kerala India Department of Cardiac Anaesthesia Malabar Institute of Medical Sciences Kozhikode Kerala India Department of Perfusion Technology Malabar Institute of Medical Sciences Kozhikode Kerala India 

出 版 物：《World Journal of Cardiovascular Diseases》 (心血管病（英文）)

年 卷 期：2016年第6卷第6期

页      面：188-195页

学科分类：083002[工学-环境工程] 0830[工学-环境科学与工程（可授工学、理学、农学学位）] 08[工学] 

主　　题：Off-Pump Coronary Artery Bypass (OPCAB) Surgery Intra-Aortic Balloon Pump (IABP) 

摘      要：Objective: Hemodynamic deterioration during positioning of the heart has been the most critical complication of off-pump coronary artery bypass surgery. Pre-operative use of intra-aortic balloon pump has been shown to prevent this complication in high risk patients. The role of balloon pump in high risk patients has been questioned by our group. We modified the role of balloon pump in our patients, thus avoiding the conversion to cardiopulmonary bypass. Methods: 4063 off-pump coronary bypass surgeries were performed by a single surgeon in our center, over thirteen years. 130 intra-aortic balloons used between July 2002 and December 2015 were removed from the the-ater, once the distal anastomosis was performed. We studied this group of patients for—time and need for insertion, duration of balloon used, local insertion problems and survival. Results: Initially, we inserted intra-aortic balloons in high risk patients. We observed that, patients with low ejection fraction and patients with critical left main coronary artery disease were not the ones who actually needed balloon pump support. It was the patients who had ongoing ischemia, with preserved left ventricular function, and ST depression intra-operatively, who needed balloon pump support to perform complete anatomical revascularization. Conclusions: Intra-aortic balloon pump has helped us to position the heart without hemodynamic instability, thereby avoiding conversion to cardio-pulmonary bypass. This enabled us to perform off-pump surgery in virtually all areas of the heart, thus maintaining perfect hemodynamics.