Peri-operative application of intra-aortic balloon pumping reduced in-hospital mortality of patients with coronary artery disease and left ventricular dysfunction

Background:There are few reports of peri-operative application of intra-aortic balloon pumping(IABP)in patients with coronary artery disease(CAD)and different grades of left ventricular dysfunction.This study aimed to analyze the early outcomes of perioperative application of IABP in coronary artery bypass grafting(CABG)among patients with CAD and left ventricular dysfunction,and to provide a clinical basis for the peri-operative use of IABP.Methods:A retrospective analysis of 612 patients who received CABG in the General Hospital of People's Liberation Army between May 1995 and June 2014.Patients were assigned to an IABP or non-IABP group according to their treatments.Logistic regression analysis was performed to investigate the influence of peri-operative IABP implantation on in-hospital mortality.Further subgroup analysis was performed on patients with severe(ejection fraction[EF]≤35%)and mild(EF=36%-50%)left ventricular dysfunction.Results:Out of 612 included subjects,78 belonged to the IABP group(12.7%)and 534 to the non-IABP group.Pre-operative left ventricular EF(LVEF)and EuroSCOREII·predicted mortality was higher in the IABP group compared with the non-IABP group(P<0.001 in both cases),yet the two did not differ significantly in terms of post-operative in-hospital mortality(P=0.833).Regression analysis showed that IABP implantation,recent myocardial infarction,critical status,non-elective operation,and postoperative ventricular fibrillation were risk factors affecting in-hospital mortality(P<0.01 in all cases).Peri-operative IABP implantation was a protective factor against in-hospital mortality(P=0.0010).In both the severe and mild left ventricular dysfunction subgroups,peri-operative IABP implantation also exerted a protective role against mortality(P=0.0303 and P=0.0101,respectively).Conclusions:Peri-operative IABP implantation could reduce the in-hospital mortality and improve the surgical outcomes of patients with CAD with both severe and mild left ventricular dysfunction.

Effects of Surgical Ventricular Restoration on Left Ventricular Shape, Size, and Function for Left Ventricular Anterior Aneurysm

Background： Surgical ventricular restoration （SVR） has been performed to treat left ventricular （LV） aneurysm. However, there is limited analysis of changes in LV shape. This study aimed to evaluate the changes in LV shape induced by SVR and the effects of SVR on LV size and function for LV aneurysm. Methods： Between April 2006 and March 2015, 18 patients with dyskinetic （dyskinetic group） and 12 patients with akinetic （akinetic group） postinfarction LV anterior aneurysm receiving SVR with the Dor procedure at Chinese People＇s Liberation Army General Hospital were enrolled in this study. A retrospective analysis was carried out using data from the echocardiography database. LV shape was analyzed by calculating the apical conicity index （ACI）. LV end-diastolic volume index, end-systolic volume index, and ejection fraction （EF） were measured. One-way analysis of variance was used to compare means at different time points within each group. Results： Within one week after SVR, LV shape became more conical in the two groups （ACI decreased from 0.84 ± 0.13 to 0.69 ± 0.11 [t = 5.155, P = 0.000] in dyskinetic group and from 0.73 ± 0.07 to 0.60 ± 0.11 [t = 2.701, P = 0.026] in akinetic group; LV volumes were decreased significantly and became closer to normal values and EF was improved significantly in the two groups）. On follow-up at least one year, LV shape remained unchanged in dyskinetic group （ACI increased from 0.69 ± 0.11 to 0.74 ± 0.12, t = - 1.109, P = 0.294）, but became more spherical in akinetic group （ACI significantly increased from 0.60 ± 0.11 to 0.75 ±0.11, t = -I .880, P = 0.047）; LV volumes remained unchanged in dyskinetic group, but increased significantly in akinetic group and EF remained unchanged in the two groups. Conclusions： SVR could reshape LV to a more conical shape and a more normal size and improve LV function significantly early after the procedure in patients with dyskinetic or akinetic postinfarction LV anterior aneurysm. However, LV tends to be more spherical and enlarged in the akinetic group on at least 1-year follow-up.

Optimal Timing of Surgical Revascularization for Myocardial Infarction and Left Ventricular Dysfunction

Background： The optimal timing of surgical revascularization for patients presenting with ST-segment elevation myocardial infarction （STEMI） and impaired left ventricular function is not well established. This study aimed to examine the timing of surgical revascularization after STEMI in patients with ischemic heart disease and left ventricular dysfunction （LVD） by comparing early and late results. Methods： From January 2003 to December 2013, there were 2276 patients undergoing isolated coronary artery bypass grafting （CABG） in our institution. Two hundred and sixty-four （223 male, 41 females） patients with a history of STEMI and LVD were divided into early revascularization （ER, 〈3 weeks）, mid-term revascularization （MR, 3 weeks to 3 months）, and late revascularization （LR, 〉3 months） groups according to the time interval from STEMI to CABG. Mortality and complication rates were compared among the groups by Fisher＇s exact test. Cox regression analyses were performed to examine the effect of the time interval of surgery on long-term survival. Results： No significant differences in 30-day mortality, long-term survival, freedom from all-cause death, and rehospitalization for heart failure existed among the groups （P 〉 0.05）. More patients in the ER group （12.90%） had low cardiac output syndrome than those in the MR （2.89%） and LR （3.05%） groups （P = 0.035）. The mean follow-up times were 46.72 ± 30.65, 48.70 ± 32.74, and 43.75 ± 32.43 months, respectively （P = 0.716）. Cox regression analyses showed a severe preoperative condition （odds ratio = 7.13, 95% confidence interval 2.05-24.74, P = 0.002） rather than the time interval of CABG （P 〉 0.05） after myocardial infarction was a risk factor of long-term survival. Conclusions： Surgical revascularization for patients with STEMI and LVD can be performed at different times after STEMI with comparable operative mortality and long-term survival. However, ER （〈3 weeks） has a higher incidence of postoperative low cardiac output syndrome. A severe preoperative condition rather than the time interval of CABG after STEMI is a risk factor of long-term survival.