Preoperative intra-aortic counterpulsation in high-risk patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials

摘要: In contrast to the results of previous studies, recent randomized controlled trials (RCTs) failed show a benefit prophylactic aortic counterpulsation in high-risk patients undergoing cardiac surgery. The present analysis aims redefine effects this treatment modality light new evidence. MEDLINE, EMBASE, CENTRAL/CCTR, Google Scholar and reference lists relevant articles were searched for full-text RCTs English or German. Assessments eligibility, relevance, study validity data extraction performed by two reviewers independently using prespecified criteria. primary outcome was hospital mortality. A total nine eligible with 1171 identified: 577 treated preoperatively intra-aortic balloon pump (IABP) 594 served as controls. pooled odds ratio (OR) mortality (22 deaths intervention arm, 54 control group) 0.381 (95% CI 0.230-0.629; P < 0.001). analyses five including only isolated on-pump coronary artery bypass grafting (n[IABP] = 348, n[control] 347) also showed statistically significant improvement preoperative IABP implantation (fixed-effects model: OR 0.267, 95% 0.129-0.552, from off-pump 0.556 model, 0.207-1.493, 0.226). Preoperative associated reduction low output syndrome (LCOS) population 0.330, 0.214-0.508, 0.001) well subgroup CAGB 0.113, 0.056-0.226, 0.001), whereas there no 0.555, 0.209-1.474, 0.238). intensive care unit (ICU) stay all investigated populations greater effect [fixed-effects standard mean difference (SMD) -0.931 ± 0.198, 0.001] SMD -1.240 0.156, compared group -0.723 0.128, Despite contradictory trials, confirms findings meta-analyses that reduces mortality, incidence LCOS ICU requirement However, owing small sample sizes lack clear-cut definition patients, an adequately powered, prospective RCT is necessary find definite answer question, if certain groups surgery insertion.