Intra-Aortic Balloon Counterpulsation after Primary and Redo Mitral and/or Aortic Valve Replacements in Rheumatic Heart Disease: Results and Guidelines for Candidate Selection

Authors: Chowdhury UK*, George N, Sankhyan LK, Malik V, Chauhan A, Gudala V, Hasija S and Kalaivani M

DOI: 10.23880/oajc-16000140

Volume 3, Issue 1

Abstract

Objective: The relationship between the timing of intra-aortic balloon counterpulsation (IABC) and surgical outcome in high-risk patients undergoing valve replacements remain debatable. Perioperative IABC is commenced either prophylactically or after increasing inotropic support has proved inadequate. This study evaluates the effect timings of IABC support on the in-hospital mortality in patients undergoing valve replacements. Methods: One hundred and twenty high-risk patients aged between 22-72 years (mean±SD: 49.68±22.6) undergoing mitral and/or aortic valve replacements requiring IABC between 1998 and 2018 were studied. Thirty-five (29.1%) patients were hemodynamically compromised and required preoperative IAB support (group I), 48 (40%) patients required intraoperative IAB support (group II), and 37 (30.8%) patients required postoperative IAB support. The independent predictors of operative mortality were determined by means of stepwise logistic regression analysis. Results: The overall operative mortality was 19.1%. Mortality was 5.7% in group I, 18.7% in group II and 32.4% in group III. The independent predictors of operative mortality were (odds ratio in parentheses) urgency of operation (4.66), low body mass index (4.15), New York Heart Association (NYHA) class IV (2.82), renal failure requiring dialysis (3.44), preoperative ventilation (3.68), left ventricular ejection fraction <30% (3.15), previous cardiac surgery (3.83) and postoperative institution of IABC (5.88).Conclusion: Patients who warrant IABC in the postoperative setting have a significantly increased operative mortality when compared to any other group. Therefore, earlier IAB support in patients with advanced functional class (NYHA-IV), requiring increasing inotropes on ventilator with metabolic/lactic acidosis, in acute pulmonary edema and oliguria/anuria as part of surgical strategy may help to improve outcome.

Keywords: Rheumatic Heart Disease; Intra-aortic Balloon Counterpulsation; Operative Mortality; Low Cardiac Output Syndrome; Mitral Valve Replacement; Aortic Valve Replacement

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