抄録
We analyzed the survival data on 76 patients undergoing cardiac surgery by the use of IABP. There were 46 patients with ischemic heart disease(IHD, G-I), 21 with valvular heart disease (VHD, C-II) and 9 with congenital heart disease(CHD, G-III). In G-I, the purposes of the use of IABP were (1) use at emergency operation for cardiogenic shock and mechanical complications of acute myocardial infarction (2) intraoperative use for the difficulty of weaning from extracorporeal circulation (ECC) or postoperative use for severe low output syndrome (LOS) (3) prophylactic and elective use for high risk patients (uncontrolled angina, poor left ventricular function, left main trunk disease). The survival rates for each use were 12.5, 50 and 86%, respectively. The use of IABP in G-II was mainly for intra and postoperative events equivalent to the purpose of (2) in G-I. The survival rate in this group was 43%. No appreciative difference in survival rates was present between the patients with mitral and aortic valve diseases. One patients with acute ischemic changes due to coronary air embolism responded dramatically well to IABP. The survival rate in G-III was low, 12.5%. No good response to IABP was observed in patients with LOS due to residual pulmonary stenosis. The only responder was a patient with right heart bypass surgery with circulation maintained only by the left ventricle.
The elective use of IABP is most controversial on its efficacy. There were certain advantages such as easy hemodynamic stability when weaning from ECC and during the postoperative course but disadvantages also existed in 14% of the patients, mostly ischemic legs. The efficacy of the elective use of IABP could not be determined by the comparison of survival rates between the groups of patients with and without IABP because of the difference in basic pathology. The elective use of IABP can be limited to only unstable hemodynamics or ongoing ischemia existing before operation.
