Document Detail


Intraaortic balloon pumping for cardiac support: trends in practice and outcome, 1968 to 1995.
MedLine Citation:
PMID:  9104986     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: A total of 4756 cases of intraaortic balloon pump support have been recorded at the Massachusetts General Hospital since the first clinical insertion for cardiogenic shock in 1968. This report describes the patterns of intraaortic balloon use and associated outcomes over this time period. METHODS: A retrospective record review was conducted. RESULTS: Balloon use has increased to more than 300 cases a year at present. The practice of balloon placement for control of ischemia (2453 cases, 11.9% mortality) has become more frequent, whereas support for hemodynamic decompensation (congestive heart failure, hypotension, cardiogenic shock) has been relatively constant (1760 cases, 38.2% mortality). Mean patient age has increased from 54 to 66 years, and mortality has fallen from 41% to 20%. Sixty-five percent (3097/4756) of the total patient population receiving balloon support underwent cardiac surgery. Placement before the operation (2038 patients) was associated with a lower mortality (13.6%) than intraoperative (771 patients, 35.7% mortality) or postoperative use (276 patients, 35.9% mortality). Independent predictors of death with balloon pump support were insertion in the operating room or intensive care unit, transthoracic insertion, age, procedure other than angioplasty or coronary artery bypass, and insertion for cardiogenic shock. Independent predictors of death with intraoperative balloon insertion were age, mitral valve replacement, prolonged cardiopulmonary bypass, urgent or emergency operation, preoperative renal dysfunction, complex ventricular ectopy, right ventricular failure, and emergency reinstitution of cardiopulmonary bypass. CONCLUSIONS: Balloons are being used more frequently for control of ischemia in more patients who are elderly with lower mortality. An institutional bias toward preoperative use of the balloon pump appears to be associated with improved outcomes.
Authors:
D F Torchiana; G Hirsch; M J Buckley; C Hahn; J W Allyn; C W Akins; J F Drake; J B Newell; W G Austen
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  113     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  1997 Apr 
Date Detail:
Created Date:  1997-05-01     Completed Date:  1997-05-01     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  758-64; discussion 764-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Massachusetts General Hospital, Boston 02114, USA.
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MeSH Terms
Descriptor/Qualifier:
Age Distribution
Aged
Cardiac Output, Low / therapy*
Female
Humans
Intra-Aortic Balloon Pumping / adverse effects,  mortality,  trends*
Male
Middle Aged
Multivariate Analysis
Myocardial Ischemia / therapy*
Patient Selection
Physician's Practice Patterns / trends*
Predictive Value of Tests
Prognosis
Retrospective Studies
Treatment Outcome
Comments/Corrections
Comment In:
J Thorac Cardiovasc Surg. 1997 Dec;114(6):1128-9   [PMID:  9434714 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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