286 The Role of Intra-Aortic Counterpulsation in High-Risk OPCAB Surgery: A Prospective Randomized Study Jan T. Christenson, M.D., Ph.D., F.E.T.C.S., * Marc Licker, M.D., ** and Afksendiyos Kalangos, M.D. * * Clinic for Cardiovascular Surgery and ** Anesthesiology, University Hospital, Geneva, Switzerland ABSTRACT Background: High-risk patients would benefit the most of OPCAB revascularization. This prospective and randomized study evaluates the efficacy and safety of pre- and periopera- tive IABC in high-risk OPCAB. Material: Group A—IABC started prior to induction of anesthesia (n = 15); group B—no preoperative IABC (n = 15). Adult high-risk coronary patients to undergo OPCAB. High risk = (minimum 2) EF < 0.30, left main stenosis, unstable angina, redo. Bailout if hemodynamic instability CPB or IABC in group B. Study endpoints (a) cardiac protection (troponin 1, cardiac index (CI), ECG), (b) inflammatory response (lactate, IL-6), (c) clinical outcome (mortality, morbidity). Emergency operations 33%, re-operation 13%, unstable angina 100%, left main 60% and EF 0.29, without group differences. Results: No bailout group A, 10 in group B, p < 0.0001. Postoperative IABC six (group A) and seven patients (group B), during 6.8 ± 5.1 hours (group A) versus 41.2 ± 25.5 hours (group B), p = 0.0110. Myocardial protection without group differences, but CI significantly better in group A. Inflammatory response significantly less in group A. Clinical outcomes: one death, one MI and two renal failure in group B, none in group A. Intensive care unit (ICU) stay 27 ± 3 hours (group A) versus 65 ± 28 hours (group B), p = 0.0017. LOS 8 ± 2 days (group A) versus 15 ± 10 (group B), p = 0.0351. No IABC related complications. Conclusions: Pre- and perioperative IABC therapy offers efficient hemodynamic support during high-risk OPCAB surgery, lowers the risk of hemodynamic instability, is safe and shortens both ICU and hospital length of stay significantly, and is a cost-effective therapy. (J Card Surg 2003;18:286-294) Coronary artery disease (CAD) is a widely spread disease and the major contributor to pre- mature death in the world. CAD is a preventable disease, but before adequate preventive pro- This study was supported by a research Grant from Datascope Corp., Fairfield, NJ. Address for correspondence: Dr. Jan T. Christenson, M.D., MA, Ph.D., F.E.T.C.S., Clinic for Cardiovascular Surgery, Uni- versity Hospital, 24 rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland. Fax: +41 22 3727634; e-mail: JTChristenson@ hotmail.com grams have become available, improved and cost- efficient management of patients with CAD is of great importance, since these patients consume a large proportion of available health resources. With improved invasive cardiology techniques, such as balloon dilatation and stenting together with a continuous limited numbers of donor hearts for transplantation 1 and poor long-term re- sults of medical treatment alone of ischemic heart disease, 2 cardiac surgeons are faced with an in- creasing number of high-risk coronary patients.