Efficacy and cost-effectiveness of preoperative IABP in patients with ejection fraction of 0.25 or less
The purposes of this study are to determine whether patients with severe left ventricular dysfunction benefit from prophylactic insertion of an intraaortic balloon pump and to evaluate its coste-ffectiveness. Between January 1991 and December 1995, 163 consecutive patients with a left ventricular ej...
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Veröffentlicht in: | The Annals of thoracic surgery 1996-08, Vol.62 (2), p.401-409 |
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creator | Dietl, Charles A. Berkheimer, Marie D. Woods, Edward L. Gilbert, Christian L. Pharr, William F. Benoit, Charles H. |
description | The purposes of this study are to determine whether patients with severe left ventricular dysfunction benefit from prophylactic insertion of an intraaortic balloon pump and to evaluate its coste-ffectiveness.
Between January 1991 and December 1995, 163 consecutive patients with a left ventricular ejection fraction of 0.25 or less underwent isolated coronary artery bypass grafting. An intraaortic balloon pump was inserted before operation in 37 patients (group A). The remaining 126 patients underwent operation without preoperative insertion of the device (group B). Preoperatively, 91.9% (34/37) of group A patients and 54.8% (69/126) of group B patients were in New York Heart Association functional class III or IV (
p < 0.001).
The 30-day mortality rate was 2.7% (1/37) and 11.9% (15/126) for groups A and B, respectively (
p < 0.005). All deaths occurred in patients in functional class III or IV. In group B, 28 patients (22.2%) required an intraaortic balloon pump after cardiotomy for low cardiac output, 42.9% (12/28) of whom died. Median post-operative hospital stay was 9.9 days and 12.0 days, and mean hospital charges were $50,627 and $54,818 for survivors in groups A and B, respectively (
p = not significant).
Our experience suggests that patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting may benefit from preoperative intraaortic balloon pump insertion, especially patients in functional class III or IV. This approach improved survival significantly, reduced hospital stay, and was more cost-effective. |
doi_str_mv | 10.1016/0003-4975(96)00244-5 |
format | Article |
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Between January 1991 and December 1995, 163 consecutive patients with a left ventricular ejection fraction of 0.25 or less underwent isolated coronary artery bypass grafting. An intraaortic balloon pump was inserted before operation in 37 patients (group A). The remaining 126 patients underwent operation without preoperative insertion of the device (group B). Preoperatively, 91.9% (34/37) of group A patients and 54.8% (69/126) of group B patients were in New York Heart Association functional class III or IV (
p < 0.001).
The 30-day mortality rate was 2.7% (1/37) and 11.9% (15/126) for groups A and B, respectively (
p < 0.005). All deaths occurred in patients in functional class III or IV. In group B, 28 patients (22.2%) required an intraaortic balloon pump after cardiotomy for low cardiac output, 42.9% (12/28) of whom died. Median post-operative hospital stay was 9.9 days and 12.0 days, and mean hospital charges were $50,627 and $54,818 for survivors in groups A and B, respectively (
p = not significant).
Our experience suggests that patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting may benefit from preoperative intraaortic balloon pump insertion, especially patients in functional class III or IV. This approach improved survival significantly, reduced hospital stay, and was more cost-effective.</description><identifier>ISSN: 0003-4975</identifier><identifier>EISSN: 1552-6259</identifier><identifier>DOI: 10.1016/0003-4975(96)00244-5</identifier><identifier>PMID: 8694598</identifier><language>eng</language><publisher>Netherlands: Elsevier Inc</publisher><subject>Aged ; Angina, Unstable - surgery ; Angina, Unstable - therapy ; Cardiac Output, Low - classification ; Cardiac Output, Low - surgery ; Cardiac Output, Low - therapy ; Coronary Artery Bypass ; Cost-Benefit Analysis ; Female ; Heart Failure - classification ; Heart Failure - surgery ; Heart Failure - therapy ; Hospital Charges ; Humans ; Intra-Aortic Balloon Pumping - economics ; Length of Stay ; Male ; Multivariate Analysis ; Postoperative Care ; Preoperative Care ; Retrospective Studies ; Risk Factors ; Stroke Volume ; Survival Rate ; Ventricular Dysfunction, Left - prevention & control ; Ventricular Dysfunction, Left - surgery</subject><ispartof>The Annals of thoracic surgery, 1996-08, Vol.62 (2), p.401-409</ispartof><rights>1996 The Society of Thoracic Surgeons</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c370t-1122034ded99e541205be67f23574e639ff7538a527b072e819bc74119a89f53</citedby><cites>FETCH-LOGICAL-c370t-1122034ded99e541205be67f23574e639ff7538a527b072e819bc74119a89f53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/0003-4975(96)00244-5$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,781,785,3551,27926,27927,45997</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8694598$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dietl, Charles A.</creatorcontrib><creatorcontrib>Berkheimer, Marie D.</creatorcontrib><creatorcontrib>Woods, Edward L.</creatorcontrib><creatorcontrib>Gilbert, Christian L.</creatorcontrib><creatorcontrib>Pharr, William F.</creatorcontrib><creatorcontrib>Benoit, Charles H.</creatorcontrib><title>Efficacy and cost-effectiveness of preoperative IABP in patients with ejection fraction of 0.25 or less</title><title>The Annals of thoracic surgery</title><addtitle>Ann Thorac Surg</addtitle><description>The purposes of this study are to determine whether patients with severe left ventricular dysfunction benefit from prophylactic insertion of an intraaortic balloon pump and to evaluate its coste-ffectiveness.
Between January 1991 and December 1995, 163 consecutive patients with a left ventricular ejection fraction of 0.25 or less underwent isolated coronary artery bypass grafting. An intraaortic balloon pump was inserted before operation in 37 patients (group A). The remaining 126 patients underwent operation without preoperative insertion of the device (group B). Preoperatively, 91.9% (34/37) of group A patients and 54.8% (69/126) of group B patients were in New York Heart Association functional class III or IV (
p < 0.001).
The 30-day mortality rate was 2.7% (1/37) and 11.9% (15/126) for groups A and B, respectively (
p < 0.005). All deaths occurred in patients in functional class III or IV. In group B, 28 patients (22.2%) required an intraaortic balloon pump after cardiotomy for low cardiac output, 42.9% (12/28) of whom died. Median post-operative hospital stay was 9.9 days and 12.0 days, and mean hospital charges were $50,627 and $54,818 for survivors in groups A and B, respectively (
p = not significant).
Our experience suggests that patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting may benefit from preoperative intraaortic balloon pump insertion, especially patients in functional class III or IV. This approach improved survival significantly, reduced hospital stay, and was more cost-effective.</description><subject>Aged</subject><subject>Angina, Unstable - surgery</subject><subject>Angina, Unstable - therapy</subject><subject>Cardiac Output, Low - classification</subject><subject>Cardiac Output, Low - surgery</subject><subject>Cardiac Output, Low - therapy</subject><subject>Coronary Artery Bypass</subject><subject>Cost-Benefit Analysis</subject><subject>Female</subject><subject>Heart Failure - classification</subject><subject>Heart Failure - surgery</subject><subject>Heart Failure - therapy</subject><subject>Hospital Charges</subject><subject>Humans</subject><subject>Intra-Aortic Balloon Pumping - economics</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Multivariate Analysis</subject><subject>Postoperative Care</subject><subject>Preoperative Care</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Stroke Volume</subject><subject>Survival Rate</subject><subject>Ventricular Dysfunction, Left - prevention & control</subject><subject>Ventricular Dysfunction, Left - surgery</subject><issn>0003-4975</issn><issn>1552-6259</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1996</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMtOAyEUhonR1Fp9A01YGV2MAgPDsDGpjZcmJrpwTyhzUJp2GGGq8e1l0qZLV3D4Lyd8CJ1TckMJrW4JIWXBlRRXqromhHFeiAM0pkKwomJCHaLx3nKMTlJa5pFleYRGdaW4UPUYfTw4562xv9i0DbYh9QU4B7b339BCSjg43EUIHUQzvOH59P4N-xZ3eYS2T_jH958YlkMktNhFs73kHLlhAoeIV7nnFB05s0pwtjsn6P3x4X32XLy8Ps1n05fClpL0BaWMkZI30CgFglNGxAIq6VgpJIeqVM5JUdZGMLkgkkFN1cJKTqkytXKinKDLbW0Xw9cGUq_XPllYrUwLYZO0zAFSksHIt0YbQ0oRnO6iX5v4qynRA149sNMDO62GIePVQ-xi179ZrKHZh3Y8s3631SH_8dtD1MlmTBYaHzMh3QT__4I_YAKH-g</recordid><startdate>19960801</startdate><enddate>19960801</enddate><creator>Dietl, Charles A.</creator><creator>Berkheimer, Marie D.</creator><creator>Woods, Edward L.</creator><creator>Gilbert, Christian L.</creator><creator>Pharr, William F.</creator><creator>Benoit, Charles H.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19960801</creationdate><title>Efficacy and cost-effectiveness of preoperative IABP in patients with ejection fraction of 0.25 or less</title><author>Dietl, Charles A. ; Berkheimer, Marie D. ; Woods, Edward L. ; Gilbert, Christian L. ; Pharr, William F. ; Benoit, Charles H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c370t-1122034ded99e541205be67f23574e639ff7538a527b072e819bc74119a89f53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1996</creationdate><topic>Aged</topic><topic>Angina, Unstable - surgery</topic><topic>Angina, Unstable - therapy</topic><topic>Cardiac Output, Low - classification</topic><topic>Cardiac Output, Low - surgery</topic><topic>Cardiac Output, Low - therapy</topic><topic>Coronary Artery Bypass</topic><topic>Cost-Benefit Analysis</topic><topic>Female</topic><topic>Heart Failure - classification</topic><topic>Heart Failure - surgery</topic><topic>Heart Failure - therapy</topic><topic>Hospital Charges</topic><topic>Humans</topic><topic>Intra-Aortic Balloon Pumping - economics</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Multivariate Analysis</topic><topic>Postoperative Care</topic><topic>Preoperative Care</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Stroke Volume</topic><topic>Survival Rate</topic><topic>Ventricular Dysfunction, Left - prevention & control</topic><topic>Ventricular Dysfunction, Left - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dietl, Charles A.</creatorcontrib><creatorcontrib>Berkheimer, Marie D.</creatorcontrib><creatorcontrib>Woods, Edward L.</creatorcontrib><creatorcontrib>Gilbert, Christian L.</creatorcontrib><creatorcontrib>Pharr, William F.</creatorcontrib><creatorcontrib>Benoit, Charles H.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Annals of thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dietl, Charles A.</au><au>Berkheimer, Marie D.</au><au>Woods, Edward L.</au><au>Gilbert, Christian L.</au><au>Pharr, William F.</au><au>Benoit, Charles H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy and cost-effectiveness of preoperative IABP in patients with ejection fraction of 0.25 or less</atitle><jtitle>The Annals of thoracic surgery</jtitle><addtitle>Ann Thorac Surg</addtitle><date>1996-08-01</date><risdate>1996</risdate><volume>62</volume><issue>2</issue><spage>401</spage><epage>409</epage><pages>401-409</pages><issn>0003-4975</issn><eissn>1552-6259</eissn><abstract>The purposes of this study are to determine whether patients with severe left ventricular dysfunction benefit from prophylactic insertion of an intraaortic balloon pump and to evaluate its coste-ffectiveness.
Between January 1991 and December 1995, 163 consecutive patients with a left ventricular ejection fraction of 0.25 or less underwent isolated coronary artery bypass grafting. An intraaortic balloon pump was inserted before operation in 37 patients (group A). The remaining 126 patients underwent operation without preoperative insertion of the device (group B). Preoperatively, 91.9% (34/37) of group A patients and 54.8% (69/126) of group B patients were in New York Heart Association functional class III or IV (
p < 0.001).
The 30-day mortality rate was 2.7% (1/37) and 11.9% (15/126) for groups A and B, respectively (
p < 0.005). All deaths occurred in patients in functional class III or IV. In group B, 28 patients (22.2%) required an intraaortic balloon pump after cardiotomy for low cardiac output, 42.9% (12/28) of whom died. Median post-operative hospital stay was 9.9 days and 12.0 days, and mean hospital charges were $50,627 and $54,818 for survivors in groups A and B, respectively (
p = not significant).
Our experience suggests that patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting may benefit from preoperative intraaortic balloon pump insertion, especially patients in functional class III or IV. This approach improved survival significantly, reduced hospital stay, and was more cost-effective.</abstract><cop>Netherlands</cop><pub>Elsevier Inc</pub><pmid>8694598</pmid><doi>10.1016/0003-4975(96)00244-5</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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source | MEDLINE; Access via ScienceDirect (Elsevier); Alma/SFX Local Collection; EZB Electronic Journals Library |
subjects | Aged Angina, Unstable - surgery Angina, Unstable - therapy Cardiac Output, Low - classification Cardiac Output, Low - surgery Cardiac Output, Low - therapy Coronary Artery Bypass Cost-Benefit Analysis Female Heart Failure - classification Heart Failure - surgery Heart Failure - therapy Hospital Charges Humans Intra-Aortic Balloon Pumping - economics Length of Stay Male Multivariate Analysis Postoperative Care Preoperative Care Retrospective Studies Risk Factors Stroke Volume Survival Rate Ventricular Dysfunction, Left - prevention & control Ventricular Dysfunction, Left - surgery |
title | Efficacy and cost-effectiveness of preoperative IABP in patients with ejection fraction of 0.25 or less |
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