Prophylactic Use of Intra-aortic Balloon Pump Counterpulsation before High Risk Coronary Artery Bypass Grafting Patients: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 Abuduwaili , LIJun-hong , AIKEREMU ,  MuLa-Ti

Department of Cardiac Surgery Division One, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding author：

MuLa-Ti, Email: muratvkili@hotmail.com

Keywords：

Coronary artery bypass grafting; Intra-aortic balloon pump counterpulsation; Preoperative; Metaanalysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20150212

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Objective To systematically review the efficacy and safety of prophylactic use of intra-aortic balloon pump counterpulsation (IABP) before coronary artery bypass grafting (CABG) in high risk patients. Methods Databases including The Cochrane Library (Issue 2, 2014), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were electronically searched from inception to July 2014, to collect randomized controlled trials (RCTs) and cohort studies about prophylactic use of IABP before CABG in high risk patients. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.2 software. Results A total of 6 RCTs and 6 cohort studies involving 1 359 patients were included, of which 633 prophylactically used IABP before CABG (the IABP group) and 736 didn't prophylactically use IABP before CABG (the control group). The results of meta-analysis showed that: compared with the control group, prophylactic use of IABP could significantly reduce perioperative mortality (RCT: OR=0.15, 95%CI 0.06 to 0.38, P<0.000 1; cohort study: OR=0.36, 95%CI 0.19 to 0.67, P=0.001) and postoperative LCOS (RCT: OR=0.23, 95%CI 0.12 to 0.43, P<0.000 01; cohort study: OR=0.21, 95%CI 0.10 to 0.43, P<0.000 1); there was no significant difference between two groups in incidence rate of postoperative myocardial infarction (MI) (RCT: OR=0.34, 95%CI 0.10 to 1.11, P=0.07; cohort study: OR=0.56, 95%CI 0.26 to 1.24, P=0.15); the results of combined analyses of RCTs showed that, prophylactic use of IABP could significantly reduce postoperative ICU stay (MD=-42.94, 95%CI -56.11 to -29.76, P<0.000 01) and postoperative hospital stay (MD=-3.83, 95%CI-5.82 to -1.85, P=0.0002), but these differences were not found in the results of combined analyses of cohort studies (MD=-4.68, 95%CI 20.69 to 11.33, P=0.57; MD=-0.77, 95%CI -1.80 to 0.26, P=0.14). Conclusion Prophylactic use of IABP before CABG in high risk patients can significantly reduce the perioperative mortality, postoperative LCOS and the length of ICU stay, however it cannot reduce postoperative MI. Due to the limited quantity and quality of included studies, the above conclusions still need to be verified by more high quality studies.

Citation： Abuduwaili, LIJun-hong, AIKEREMU, MuLa-Ti. Prophylactic Use of Intra-aortic Balloon Pump Counterpulsation before High Risk Coronary Artery Bypass Grafting Patients: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(11): 1284-1292. doi: 10.7507/1672-2531.20150212 Copy

1.	Sezai A, Nakata K, Iida M, et al. Results of low-dose earperitide infusion in high-risk patients undergoing coronary artery bypass grafting. Ann Thorac Surg, 2013, 96(1):119-126.
2.	Suzuki T, Okabe M, Hands M, et al. Usefulness of preoperative intra-aortic balloon pump therapy during off-pump coronary artery bypass grafting in high-risk patients. Ann Thorac Surg, 2004, 7(6): 2056-2060.
3.	Miceli A, Fiorani B, Danesi TH, et al. Prophylactic intra-aortic balloon pump in high-risk patients undergoing coronary artery bypass grafting:a propensity score analysis. Interact Cardiovasc Thorac Surg, 2009, 9(2):291-294.
4.	Sá MP, Ferraz PE, Escobar RR, et al. Prophylactic intra-aortic balloon pump in high-risk patients undergoing coronary artery bypass surgery:a meta-analysis of randomized controlled trials. Coron Artery Dis, 2012, 23(7):480-486.
5.	Dyub AM, Whitlock RP, Abouzahr LL, et al. Preoperative intraaortic balloon pump in patients undergoing coronary bypass surgery:a systematic review and meta-analysis. J Card Surg, 2008, 23(1):79-86.
6.	Vohra HA, Dimitri WR. Elective intra aortic balloon counter pulsation in high-risk off-pump coronary artery bypass grafting. J Card Surg, 2006, 21(1):1-5.
7.	Holman W, Qing L, Kiefe C, et al. Prophylactic value of preincision intra-aortic balloon pump:analysis of a state wide experience. J Thorac Cardiovasc Surg, 2000, 120(6):1112-1119.
8.	Gutfinger DE, Ott RA, Miller M, et al. Aggressive preoperative use of intra-aortic balloon pump in elderly patients undergoing coronary artery bypasses grafting. Ann Thorac Surg, 1999, 67(3):610-613.
9.	Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). Available at:http://www.cochranehandbook.org.
10.	Wells G, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non randomized studies in meta analyses. Available at:http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.
11.	Christenson JT, Simonet F, Badel P, et al. Preoperative intraaortic balloon pump enhances cardiac performance and improves the outcome of redo CABG. Ann Thorac Surg, 1997, 64(5):1237-1244.
12.	Christenson JT, Simonet F, Badel P, et al. Optimal timing of preoperative intraaortic balloon pump support in high risk coronary patients. Ann Thorac Surg, 1999, 68(3):934-939.
13.	Marra C, De Santo LS, Amarelli C, et al. Coronary artery bypass grafting in patients with severe left ventricular dysfunction:a prospective randomized study on the timing of perioperative intraaortic balloon pump support. Int J Artif Organs, 2002, 25(2): 141-146.
14.	Christenson JT, Liker M, Kalangos A. The role of intraaortic counterpulsation in high risk OPCAB surgery:a prospective randomized study. J Card Surg, 2003, 18(4), 286-294.
15.	王辉, 卢家凯, 吕誉芳. 主动脉内球囊反搏在冠心病高危患者行非体外循环冠脉旁路移植手术中的应用. 临床麻醉学杂志, 2012, 28(10):998-1000.
16.	Christenson JT, Simonet F, Badel P, et al. Evaluation of preoperative intra-aortic balloon pump support in high risk coronary patients. Eur J Cardiothorac Surg, 1997, 11(6):1097-1104.
17.	Kim KB, Lim C, Ahn H, et al. Intraaortic balloon pump therapy facilitates posterior vessel off-pump coronary artery bypass grafting in high-risk patients. Ann Thorac Surg, 2001, 7l(6):1964-1968.
18.	Wilczynski M, Krzych LJ, Bis J, et al. Effect of gender on efficacy of preoperative intra-aortic balloon pump in high risk patients undergoing surgical coronary revascularization. Kardiol Pol, 2010, 68(12):1361-1368.
19.	丁文军, 魏强, 孙勇新, 等. 主动脉内球囊反搏在高危患者非体外循环冠状动脉旁路移植术中的应用. 中国胸心血管外科临床杂志, 2013, 20(1):10-14.
20.	Moulopoulous SD, Topaz S, Kolff WJ. Diastolic balloon pumping (with carbon dioxide) in the aorta-a mechanical assist to the failing circulation. Am Heart J, 1962, 63:669-675.
21.	Perera D, Stables R, Thomas M, et al. Elective intra-aortic balloon counter pulsation during high-risk percutaneous coronary intervention:a randomized controlled trial. JAMA, 2010, 304(8): 867-874.
22.	Bonios MJ, Pierrakos CN, Argiriou M, et al. Increase in coronary blood flow by intra-aortic balloon counterpulsation in a porcine model of myocardial reperfusion. Int J Cardiol, 2010, 138(3):253-260.
23.	Baskett RJ, Ghali WA, Maitland A, et al. The intra-aortic balloon pump in cardiac surgery. Ann Thorac Surg, 2002, 74(4):1276-1287.
24.	Creswell LL, Moulton MJ, Cox JL, et al. Revascularization after acute myocardial infarction. Ann Thorac Surg, 1995, 60(1):19-26.
25.	Lavana JD, Fraser JF, Smith SE, et al. Influence of timing of intraaortic balloon placement in cardiac surgical patients. J Thorac Cardiovasc Surg, 2010, 140(1):80-85.
26.	Parissis H, Leotsinidis M, Akbar MT, et al. The need for intraaortic balloon pump following open heart surgery:risk analysis and outcome. J Cardiothorac Surg, 2010, 5:20.
27.	Arafa OE, Pedersen TH, Svennevig JL, et al. Intraaortic balloon pump in open heart operations:10-year follow-up with risk analysis. Ann Thorac Surg, 1998, 65(3):741-747.
28.	Mannacio V, Tommaso LD, Amicis VD, et al. Preoperative intraaortic balloon pump for off-pump coronary arterial revascularization. Ann Thorac Surg, 2012, 93(3):804-809.
29.	Santarpino G, Onorati F, Rubino AS, et al. preoperative intraaortic balloon pumping improves outcomes for high-risk patients in routine coronary artery bypass graft surgery. Ann Thorac Surg, 2009, 87(2):481-488.
30.	Gong Q, Xing J, Miao N, et al. Beneficial effect of preventative intraaortic balloon pumping in high-risk patients undergoing first-time coronary artery bypass grafting-a single center experience. Artif Organs, 2009, 33(8):587-592.
31.	Christenson JT, Schmuziger M, Simonet F. Effective surgical management of high-risk coronary patients using preoperative intra-aortic balloon counterpulsation therapy. Cardiovasc Surg, 2001, 9(4):383-390.
32.	Lorusso R, Gelsomino S, Carella R, et al. Impact of prophylactic intra-aortic balloon counter-pulsation on postoperative outcome in high-risk cardiac surgery patients:a multicentre, propensity-score analysis. Eur J Cardiothorac Surg, 2010, 38(5):585-591.
33.	Etienne PY, Papadatos S, Glineur D, et al. Reduced mortality in high-risk coronary patients operated off pump with preoperative intra aortic balloon counter pulsation. Ann Thorac Surg, 2007, 84(2): 498-502.
34.	Christenson JT, Simonet F, Schmuziger M. Economic impact of preoperative intra aortic balloon pump therapy in high-risk coronary patients. Ann Thorac Surg, 2000, 70(2):510-515.
35.	Dietl CA, Berkheimer MD, Woods EL, et al. Efficacy and costeffectiveness of preoperative IABP in patients with ejection fraction of 0.25 or less. Ann Thorac Surg, 1996, 62(2):401-409.

1. Sezai A, Nakata K, Iida M, et al. Results of low-dose earperitide infusion in high-risk patients undergoing coronary artery bypass grafting. Ann Thorac Surg, 2013, 96(1):119-126.
2. Suzuki T, Okabe M, Hands M, et al. Usefulness of preoperative intra-aortic balloon pump therapy during off-pump coronary artery bypass grafting in high-risk patients. Ann Thorac Surg, 2004, 7(6): 2056-2060.
3. Miceli A, Fiorani B, Danesi TH, et al. Prophylactic intra-aortic balloon pump in high-risk patients undergoing coronary artery bypass grafting:a propensity score analysis. Interact Cardiovasc Thorac Surg, 2009, 9(2):291-294.
4. Sá MP, Ferraz PE, Escobar RR, et al. Prophylactic intra-aortic balloon pump in high-risk patients undergoing coronary artery bypass surgery:a meta-analysis of randomized controlled trials. Coron Artery Dis, 2012, 23(7):480-486.
5. Dyub AM, Whitlock RP, Abouzahr LL, et al. Preoperative intraaortic balloon pump in patients undergoing coronary bypass surgery:a systematic review and meta-analysis. J Card Surg, 2008, 23(1):79-86.
6. Vohra HA, Dimitri WR. Elective intra aortic balloon counter pulsation in high-risk off-pump coronary artery bypass grafting. J Card Surg, 2006, 21(1):1-5.
7. Holman W, Qing L, Kiefe C, et al. Prophylactic value of preincision intra-aortic balloon pump:analysis of a state wide experience. J Thorac Cardiovasc Surg, 2000, 120(6):1112-1119.
8. Gutfinger DE, Ott RA, Miller M, et al. Aggressive preoperative use of intra-aortic balloon pump in elderly patients undergoing coronary artery bypasses grafting. Ann Thorac Surg, 1999, 67(3):610-613.
9. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). Available at:http://www.cochranehandbook.org.
10. Wells G, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non randomized studies in meta analyses. Available at:http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.
11. Christenson JT, Simonet F, Badel P, et al. Preoperative intraaortic balloon pump enhances cardiac performance and improves the outcome of redo CABG. Ann Thorac Surg, 1997, 64(5):1237-1244.
12. Christenson JT, Simonet F, Badel P, et al. Optimal timing of preoperative intraaortic balloon pump support in high risk coronary patients. Ann Thorac Surg, 1999, 68(3):934-939.
13. Marra C, De Santo LS, Amarelli C, et al. Coronary artery bypass grafting in patients with severe left ventricular dysfunction:a prospective randomized study on the timing of perioperative intraaortic balloon pump support. Int J Artif Organs, 2002, 25(2): 141-146.
14. Christenson JT, Liker M, Kalangos A. The role of intraaortic counterpulsation in high risk OPCAB surgery:a prospective randomized study. J Card Surg, 2003, 18(4), 286-294.
15. 王辉, 卢家凯, 吕誉芳. 主动脉内球囊反搏在冠心病高危患者行非体外循环冠脉旁路移植手术中的应用. 临床麻醉学杂志, 2012, 28(10):998-1000.
16. Christenson JT, Simonet F, Badel P, et al. Evaluation of preoperative intra-aortic balloon pump support in high risk coronary patients. Eur J Cardiothorac Surg, 1997, 11(6):1097-1104.
17. Kim KB, Lim C, Ahn H, et al. Intraaortic balloon pump therapy facilitates posterior vessel off-pump coronary artery bypass grafting in high-risk patients. Ann Thorac Surg, 2001, 7l(6):1964-1968.
18. Wilczynski M, Krzych LJ, Bis J, et al. Effect of gender on efficacy of preoperative intra-aortic balloon pump in high risk patients undergoing surgical coronary revascularization. Kardiol Pol, 2010, 68(12):1361-1368.
19. 丁文军, 魏强, 孙勇新, 等. 主动脉内球囊反搏在高危患者非体外循环冠状动脉旁路移植术中的应用. 中国胸心血管外科临床杂志, 2013, 20(1):10-14.
20. Moulopoulous SD, Topaz S, Kolff WJ. Diastolic balloon pumping (with carbon dioxide) in the aorta-a mechanical assist to the failing circulation. Am Heart J, 1962, 63:669-675.
21. Perera D, Stables R, Thomas M, et al. Elective intra-aortic balloon counter pulsation during high-risk percutaneous coronary intervention:a randomized controlled trial. JAMA, 2010, 304(8): 867-874.
22. Bonios MJ, Pierrakos CN, Argiriou M, et al. Increase in coronary blood flow by intra-aortic balloon counterpulsation in a porcine model of myocardial reperfusion. Int J Cardiol, 2010, 138(3):253-260.
23. Baskett RJ, Ghali WA, Maitland A, et al. The intra-aortic balloon pump in cardiac surgery. Ann Thorac Surg, 2002, 74(4):1276-1287.
24. Creswell LL, Moulton MJ, Cox JL, et al. Revascularization after acute myocardial infarction. Ann Thorac Surg, 1995, 60(1):19-26.
25. Lavana JD, Fraser JF, Smith SE, et al. Influence of timing of intraaortic balloon placement in cardiac surgical patients. J Thorac Cardiovasc Surg, 2010, 140(1):80-85.
26. Parissis H, Leotsinidis M, Akbar MT, et al. The need for intraaortic balloon pump following open heart surgery:risk analysis and outcome. J Cardiothorac Surg, 2010, 5:20.
27. Arafa OE, Pedersen TH, Svennevig JL, et al. Intraaortic balloon pump in open heart operations:10-year follow-up with risk analysis. Ann Thorac Surg, 1998, 65(3):741-747.
28. Mannacio V, Tommaso LD, Amicis VD, et al. Preoperative intraaortic balloon pump for off-pump coronary arterial revascularization. Ann Thorac Surg, 2012, 93(3):804-809.
29. Santarpino G, Onorati F, Rubino AS, et al. preoperative intraaortic balloon pumping improves outcomes for high-risk patients in routine coronary artery bypass graft surgery. Ann Thorac Surg, 2009, 87(2):481-488.
30. Gong Q, Xing J, Miao N, et al. Beneficial effect of preventative intraaortic balloon pumping in high-risk patients undergoing first-time coronary artery bypass grafting-a single center experience. Artif Organs, 2009, 33(8):587-592.
31. Christenson JT, Schmuziger M, Simonet F. Effective surgical management of high-risk coronary patients using preoperative intra-aortic balloon counterpulsation therapy. Cardiovasc Surg, 2001, 9(4):383-390.
32. Lorusso R, Gelsomino S, Carella R, et al. Impact of prophylactic intra-aortic balloon counter-pulsation on postoperative outcome in high-risk cardiac surgery patients:a multicentre, propensity-score analysis. Eur J Cardiothorac Surg, 2010, 38(5):585-591.
33. Etienne PY, Papadatos S, Glineur D, et al. Reduced mortality in high-risk coronary patients operated off pump with preoperative intra aortic balloon counter pulsation. Ann Thorac Surg, 2007, 84(2): 498-502.
34. Christenson JT, Simonet F, Schmuziger M. Economic impact of preoperative intra aortic balloon pump therapy in high-risk coronary patients. Ann Thorac Surg, 2000, 70(2):510-515.
35. Dietl CA, Berkheimer MD, Woods EL, et al. Efficacy and costeffectiveness of preoperative IABP in patients with ejection fraction of 0.25 or less. Ann Thorac Surg, 1996, 62(2):401-409.

Chinese Journal of Evidence-Based Medicine

Prophylactic Use of Intra-aortic Balloon Pump Counterpulsation before High Risk Coronary Artery Bypass Grafting Patients: A Meta-analysis

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