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Prophylaktische intraaortale Ballongegenpulsation bei herzchirurgischen Hochrisikopatienten

Prophylactic intraaortic balloon pumping in high-risk cardiac surgery patients

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Zusammenfassung

Hintergrund

Wir untersuchten die prophylaktische präoperative Implantation einer intraaortalen Ballonpumpe (IABP) in herzchirurgischen Hochrisikopatienten mit einer additiven EuroSCORE-Summe ≥8.

Material und Methoden

Randomisierte Studie mit 104 Patienten, denen prophylaktisch keine IABP (Gruppe A, n=52) oder eine IABP (Gruppe B, n=52) implantiert wurde. Primärer Endpunkt war die 30-Tagessterblichkeit.

Ergebnisse

Das mediane Alter der Patienten betrug 74 Jahre und 43% der Patienten waren Frauen. Die 30-Tagessterblichkeit unterschied sich nicht (Gruppe A 17,3% versus Gruppe B 13,4%, p=0,78). Die mediane Klinikaufenthaltsdauer betrug in beiden Gruppen 14 Tage. In Gruppe A benötigten 13 Patienten (21%) intra- und postoperativ eine IABP-Unterstützung. Mediane Beatmungszeit (14 h versus 13 h), medianer Katecholaminbedarf, Häufigkeit eines akuten dialysepflichtigen Nierenversagens (28 versus 18%), kardiale Indizes und Häufigkeit eines „Low-cardiac-output“-Syndroms (26 versus 25%) waren zwischen den Gruppen nicht signifikant verschieden.

Schlussfolgerung

Die präoperative prophylaktische IABP-Implantation in EuroSCORE-stratifizierten Patienten ist nicht mit einer reduzierten 30-Tagessterblichkeit assoziiert.

Abstract

Background

We examined the impact of prophylactic IABP insertion in EuroSCORE-stratified high-risk cardiac surgery patients with a score ≥8.

Material and methods

A randomized trial with 104 patients either without prophylactic IABP insertion (group A, n=52) or with IABP (group B, n=52) was conducted. The primary endpoint was 30-day mortality.

Results

The median age of the patients was 74 years and 43% of participants were females. The 30-day mortality did not differ between group A (17.3%) and group B (13.4%; p=0.78). The median hospital stay was 14 days in both groups. Intra- and postoperative IABP support was required by 13 patients (21%) in group A. The median ventilation time (14 hours versus 13 hours), median catecholamine dose, frequency of dialysis-dependent acute renal failure (28% versus 18%), cardiac indices, and frequency of a low cardiac output syndrome (26% versus 25%) did not significantly differ between groups.

Conclusion

Prophylactic preoperative IABP insertion in EuroSCORE-stratified high-risk patients is not associated with decreased 30-day mortality.

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Authors and Affiliations

  1. Klinik für Herz-, Thorax- und Gefäßchirurgie, MediClin Herzzentrum Coswig, Coswig, Deutschland

    D. Metz

  2. Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum Halle (Saale), Halle, Deutschland

    M. Stiller & R.-E. Silber

  3. Klinik für Anästhesiologie, Universitätsklinikum Halle (Saale), Halle, Deutschland

    H. Kroll

  4. Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland

    H.-S. Hofmann

  5. Klinik für Herz-, Thorax- und herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93052, Regensburg, Deutschland

    C. Diez

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  1. D. Metz
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  2. M. Stiller
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  3. R.-E. Silber
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  4. H. Kroll
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Correspondence to C. Diez.

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Metz, D., Stiller, M., Silber, RE. et al. Prophylaktische intraaortale Ballongegenpulsation bei herzchirurgischen Hochrisikopatienten. Med Klin 106, 125–131 (2011). https://doi.org/10.1007/s00063-011-0048-z

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  • DOI: https://doi.org/10.1007/s00063-011-0048-z

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