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DOI: 10.1055/s-0037-1598917
Intra-aortic Balloon Pump Therapy before Cardiac Surgery: A Systematic Review and Meta-analysis of 9,212 Patients
Publication History
Publication Date:
03 February 2017 (online)
Objectives: Significant changes in the use of IABP in patients who are planned for revascularization lead us to perform a wide systematic review with meta-analysis including cardiac surgery patients.
Methods: We performed a meta-analysis of randomized (RCT) and observational trials (OT) that fulfilled our inclusion criteria: (1) Group comparison of patients with prophylactic IABP implantation before CABG with a control group; (2) reporting at least one desired clinical endpoint, including all-cause mortality, myocardial infarction, cerebrovascular accident (CVA), renal failure. Pooled treatment effects (odds ratio (OR) or weighted mean difference (WMD), 95% confidence intervals (95%CI)) were assessed using a fixed or random effects model. Subgroup analyses for on-pump or off-pump revascularization were also performed.
Results: A total of 7 RCTs and 16 OTs including 9,212 patients were identified after systematic literature search of major databases. Absolute risk reduction for mortality in RCTs was 4.4% (OR: 0.43; 95% CI: 0.25–0.73; p = 0.0025). Subgroup analyses revealed only a benefit for off-pump patients (OR: 0.42; 95% CI: 0.20–0.84; p = 0.0008), whereas no beneficial effect was seen in the on-pump group (OR: 1.10; 95% CI: 0.90–1.34; p = 0.07).
In the entire collective, prophylactic IABP use before cardiac surgery also decreased risk for myocardial infarction (OR: 0.58; 95% CI: 0.43–0.78; p = 0.004), CVA (OR: 0.67; 95% CI: 0.47–0.97; p = 0.042), and renal failure (OR: 0.62; 95% CI: 0.47–0.83; p = 0.0014).
Conclusion: Prophylactic IABP use in high-risk patient before cardiac surgery should be considered, especially in high-risk patients prior off-pump revascularization.