Interact Cardiovasc Thorac Surg
· 2022 Aug · PMID 35439299
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A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'in the first 3-months after mitral valve repair (MVRep) which antiplatelet and/or anticoagulant strateg...A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'in the first 3-months after mitral valve repair (MVRep) which antiplatelet and/or anticoagulant strategy should be instigated in patients who remain in normal sinus rhythm'. Altogether 77 papers were found using the reported search, of which 8 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that there remains a lack of high-quality randomized studies, controlling for postoperative cardiac rhythm, comparing vitamin K antagonists (VKA) and antiplatelet therapy in the early postoperative period following isolated MVRep. Current guidelines are based on limited evidence or expert consensus alone. Based on the currently available evidence, the authors conclude that antiplatelet therapy (e.g. aspirin) is safe and appropriate to use in the 3-month postoperative period following isolated MVRep, in those without preoperative, or postoperative atrial fibrillation. Rates of thromboembolic events are comparable between these patient groups (i.e. VKA versus aspirin), whilst VKA therapy is associated with increased rates of major bleeding events and mortality.
Darawsha F, Kramer R, Raanani E
… +1 more, Saute M
Interact Cardiovasc Thorac Surg
· 2022 Aug · PMID 35438178
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Pulmonary artery angiosarcoma is a rare malignant vascular tumour with a poor prognosis and a grim clinical course. Common clinical presentations include shortness of breath, coughing and haemoptysis. Differential diagno...Pulmonary artery angiosarcoma is a rare malignant vascular tumour with a poor prognosis and a grim clinical course. Common clinical presentations include shortness of breath, coughing and haemoptysis. Differential diagnosis includes thromboembolism and lung carcinoma. Rarity of the tumour and the consequent lack of treatment guidelines further worsen the prognosis. We report a case of pulmonary artery angiosarcoma involving the main pulmonary artery and its bifurcation with emphasis on the surgical treatment.
Gierlinger G, Sames-Dolzer E, Kreuzer M
… +6 more, Mair R, Nawrozi MP, Tulzer A, Bauer C, Tulzer G, Mair R
Interact Cardiovasc Thorac Surg
· 2022 Aug · PMID 35438156
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OBJECTIVES: Fontan patients are at lifelong risk for developing complications, which may result in Fontan failure. Survival rates after heart transplantation (HTX) are still unsatisfying in these patients. Long-term surv...OBJECTIVES: Fontan patients are at lifelong risk for developing complications, which may result in Fontan failure. Survival rates after heart transplantation (HTX) are still unsatisfying in these patients. Long-term survival of extracardiac Fontan patients in the modern era was investigated. The objective of this study was to investigate if surgical and interventional procedures in patients with protein-losing enteropathy (PLE) and/or plastic bronchitis (PB) and a failing Fontan circulation can postpone or avoid HTX. METHODS: Retrospective data collection of all children who underwent a Fontan procedure between January 1999 and July 2021 at our centre was performed. Patients were surveyed regarding the occurrence of PLE or PB and their outcome was reported descriptively. HTX-free survival of patients who underwent a rescue procedure due to PLE/PB was evaluated. RESULTS: Three hundred and seventy [94.1% (95% confidence interval, 91.4-96.3)] Fontan patients were free of HTX or death at last follow-up after a median follow-up time of 6.7 years. PB/PLE was diagnosed in 34 patients during the observation period. A rescue procedure was undertaken in 16 pts. at a median time of 6.5 months (range: 1 day to 9.4 years) since the initial diagnosis of PLE/PB. In these patients, HTX-free survival was 75% (95% confidence interval, 47.6-92.7) at a median follow-up time of 4.0 years after the procedure. Range: 3.5 months to 13.9 years. CONCLUSIONS: Extracardiac Fontan patients in the modern era expect reasonable HTX-free survival rates. Surgical and/or interventional rescue strategies for Fontan failure can postpone HTX for a sustained period of time.
Kondov S, Frankenberger L, Siepe M
… +8 more, Keyl C, Staier K, Humburger F, Rylski B, Kreibich M, Berger T, Beyersdorf F, Czerny M
Interact Cardiovasc Thorac Surg
· 2022 Aug · PMID 35437605
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OBJECTIVES: Our goal was to evaluate outcomes in all-comer patients undergoing open thoracoabdominal aortic replacement either unsuitable for or after failed endovascular aortic repair. METHODS: Within a 4-year period, w...OBJECTIVES: Our goal was to evaluate outcomes in all-comer patients undergoing open thoracoabdominal aortic replacement either unsuitable for or after failed endovascular aortic repair. METHODS: Within a 4-year period, we analysed a consecutive series of 80 patients undergoing elective, urgent and emergency thoracoabdominal aortic replacement. Preoperative data, intraoperative data and outcomes were evaluated. Specific attention was given to technical refinements needed in patients after previous endovascular aortic repair. RESULTS: Eighty patients underwent thoracoabdominal aortic replacement: 11.3% (n = 9) had connective tissue disorders. Twenty-six patients (32.5%) had previous endovascular aortic repair and 54 (67.5%) did not have previous endovascular repair. The mean age was 64.2 ± 12 years, and 70% (n = 56) were male. The mean EuroSCORE was 7.9 ± 2.6. Urgent or emergency operations were done in 22.5% (n = 18). Overall mortality was 20% (n = 16); symptomatic spinal cord injury occurred in 5% (n = 4). We did not observe differences in survival according to the presence or absence of previous endovascular aortic repair (P = 0.524). Multivariate regression analysis revealed the amount of packed red blood cell units (P = 0.009, confidence interval 1.028-1.215, odds ratio = 1.117) as a predictor of in-hospital death. Follow-up was 100% (37.9 ± 15.8 months); freedom from aortic-related reintervention was 96.3%. CONCLUSIONS: Despite an early attrition rate, survival after open thoracoabdominal aortic replacement is excellent, and freedom from aortic-related reintervention is high. Open surgery continues to remain an essential component in the treatment armamentarium of acute and chronic thoracoabdominal aortic pathology.
Interact Cardiovasc Thorac Surg
· 2022 Aug · PMID 35437604
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The prosthetic paravalvular leak is a rare but important complication following mitral valve replacement. Determining the location of the leak is almost always dependent on perioperative transoesophageal echocardiography...The prosthetic paravalvular leak is a rare but important complication following mitral valve replacement. Determining the location of the leak is almost always dependent on perioperative transoesophageal echocardiography and the considerable expertise of echo operators. Acoustic shadowing due to the prosthetic valve may create another important difficulty. In this report, we present a case with a paravalvular leak diagnosed 1 year after mitral valve replacement. Beating heart surgery and robotic 3D/high-resolution camera provided to localize the direct location of leak coherent with perioperative echocardiography and precise repair. The robotic approach prevented the potential complications of aortic cross-clamp and resternotomy.
Kang Y, Kim JS, Cui H
… +3 more, Jang MJ, Zhang YH, Hwang HY
Interact Cardiovasc Thorac Surg
· 2022 Jul · PMID 35426918
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OBJECTIVES: The molecular basis supporting the superiority of the left internal thoracic artery (LITA) as a bypass conduit is limited. This study was conducted to compare the expression and localization of hydrogen sulph...OBJECTIVES: The molecular basis supporting the superiority of the left internal thoracic artery (LITA) as a bypass conduit is limited. This study was conducted to compare the expression and localization of hydrogen sulphide synthesizing enzymes in LITA and radial artery (RA). METHODS: Nineteen patients who underwent coronary artery bypass grafting using LITA and RA were enrolled. The remnant LITA and RA were collected to measure the expression levels of 3 hydrogen sulphide-producing enzymes: cystathionine β-synthase, cystathionine γ-lyase and 3-mercaptopyruvate sulphurtransferase using quantitative real-time polymerase chain reaction. Expression levels of these enzymes in the LITA and RA were compared in each subject. The expression and localization patterns of the enzymes were also analysed by immunohistochemistry. RESULTS: The mRNA expression of the cystathionine β-synthase was greater in the LITA than in the RA (P = 0.033), whereas the expression levels of the other 2 enzymes did not significantly differ between the 2 arteries. The immunohistochemistry analysis demonstrated greater expression of the cystathionine β-synthase in the LITA than in the RA (P = 0.006). This protein was present in both tunica intima and tunica media of the LITA, although it was present only in the tunica media of the RA. Localization patterns of the other 2 enzymes were not different between LITA and RA. CONCLUSIONS: Expression levels of the mRNA and protein of cystathionine β-synthase were significantly greater in LITA than in the RA. These findings might be a factor that affects the superior patency rate of LITA.
Kondov S, Dimov A, Beyersdorf F
… +7 more, Maruschke L, Pooth JS, Kreibich M, Kaier K, Siepe M, Czerny M, Rylski B
Interact Cardiovasc Thorac Surg
· 2022 Jun · PMID 35425973
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OBJECTIVES: Our goal was to identify the inferior mesenteric artery diameter and number of patent lumbar arteries causing a significant type 2 endoleak to develop after infrarenal endovascular aneurysm repair. MATERIAL A...OBJECTIVES: Our goal was to identify the inferior mesenteric artery diameter and number of patent lumbar arteries causing a significant type 2 endoleak to develop after infrarenal endovascular aneurysm repair. MATERIAL AND METHODS: Included were patients who underwent infrarenal endovascular aneurysm repair between April 2002 and January 2017. Patients with an aneurysm involving the iliac arteries were excluded. Significant type 2 endoleak was defined as a type 2 endoleak observed after infrarenal endovascular aneurysm repair and accompanied by abdominal aneurysm growth of at least 5 mm during that time. RESULTS: A total of 277 patients were included. Mean follow-up was 38.9 (standard deviation 121.6) months. Immediately after infrarenal endovascular aneurysm repair, type 2 endoleaks occurred in 55 patients (20%), resolving spontaneously in 2 patients 6 months after infrarenal endovascular aneurysm repair. Thirty (10.8%) patients revealed a significant type 2 endoleak with aneurysm sack enlargement > 5 mm during follow-up, for which inferior mesenteric artery or lumbar artery coiling was performed. Mean time for coiling after primary infrarenal endovascular aneurysm repair was 25.4 (standard deviation 19.10) months. Twenty-three patients (8.3%) showed a non-significant type 2 endoleak during follow-up (no aneurysm sack enlargement). We found that the inferior mesenteric artery diameter and number of patent lumbar arteries were factors associated with a significant type 2 endoleak (odds ratio 1.755, P = 0.001; odds ratio 1.717, P < 0.001, respectively). Prior to endovascular aneurysm repair, the inferior mesenteric artery was patent in 212 (76.5%) patients; its median diameter measured 3 (0.5-3.8) mm. The median number of patent lumbar arteries was 3 (2-4). According to our receiver operating characteristic curve analysis, an inferior mesenteric artery diameter ≥3 mm (sensitivity 93.3%, specificity 65%) and ≥3 patent lumbar arteries (sensitivity 87.5%, specificity 43.6%) proved to be optimal cut-off values related to developing a significant type 2 endoleak. We therefore propose a composite score for the development of a significant type 2 endoleak [(inferior mesenteric artery diameter + patent lumbar arteries)/2]. CONCLUSIONS: Patients in whom the diameter of the inferior mesenteric artery is ≥ 3 mm and with ≥ 3 patent lumbar arteries carry a higher risk of developing significant type 2 endoleak after infrarenal endovascular aneurysm repair.
Interact Cardiovasc Thorac Surg
· 2022 Jun · PMID 35417001
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We report the case of a 16-year-old boy in whom we successfully repaired a distal aortic arch aneurysm associated with pseudocoarctation using double aortic cannulation and antegrade selective cerebral perfusion through...We report the case of a 16-year-old boy in whom we successfully repaired a distal aortic arch aneurysm associated with pseudocoarctation using double aortic cannulation and antegrade selective cerebral perfusion through the L-incision approach. This approach provided excellent exposure from the ascending aorta to the descending aorta, which enabled total body perfusion. We avoided cardiac arrest and hypothermic circulatory arrest during the surgery. The L-incision approach could be a better alternative for aortic arch surgery in adolescents.
Nägele F, Engler C, Graber M
… +11 more, Remmel N, Hirsch J, Pölzl L, Huber R, Schweiger V, Kilo J, Bonaros N, Tancevski I, Grimm M, Gollmann-Tepeköylü C, Holfeld J
Interact Cardiovasc Thorac Surg
· 2022 Jun · PMID 35416983
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OBJECTIVES: The need to ration medical equipment and interventions during the coronavirus disease 2019 pandemic translated to an ever-lengthening wait list for surgical care. Retrospective analysis of lockdowns is of hig...OBJECTIVES: The need to ration medical equipment and interventions during the coronavirus disease 2019 pandemic translated to an ever-lengthening wait list for surgical care. Retrospective analysis of lockdowns is of high importance to learn from the current situation for future pandemics. This monocentric study assessed the impact of lockdown periods on cardiac surgery cases and outcomes. METHODS: The single-centre cross-sectional descriptive observational study was conducted to investigate the first lockdown period and the following post-lockdown period in comparison to the same periods during the previous 3 years at the Department of Cardiac Surgery at the Medical University of Innsbruck. Data were prospectively collected and retrospectively analysed from the department-specific quality management system. The primary objective was to compare the number of open-heart procedures between the prelockdown and the lockdown period. The secondary objectives were to analyse the characteristics and the outcomes of open-heart procedures. RESULTS: There were no differences in patient demographics. A significant decrease of 29% in weekly surgical procedures was observed during the lockdown period. The surgical case-mix was unaffected: The numbers of aortic valve replacements, coronary artery bypass grafts, mitral valve repair or replacement procedures and others remained stable. The urgency of cases increased significantly, and the general health conditions of patients appeared to be worse. However, outcomes were unchanged. CONCLUSIONS: By implementing a rational patient selection process, the quality of open-heart procedures was maintained even though patients who underwent surgery during lockdown were sicker and more symptomatic.
Bao Y, Jiang C, Wan Z
… +9 more, Wang Y, Zhong Y, Deng J, She Y, Jiang L, Hu X, Zhu Y, Yu B, Chen C
Interact Cardiovasc Thorac Surg
· 2022 Jul · PMID 35416960
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OBJECTIVES: This study intends to appraise the feasibility of double sleeve lobectomy after neoadjuvant chemotherapy in central non-small-cell lung cancer with bronchovascular aggression. METHODS: This retrospective stud...OBJECTIVES: This study intends to appraise the feasibility of double sleeve lobectomy after neoadjuvant chemotherapy in central non-small-cell lung cancer with bronchovascular aggression. METHODS: This retrospective study included non-small-cell lung cancer patients who received double sleeve lobectomy from January 2014 to June 2020. Patients were divided into 2 groups: the neoadjuvant chemotherapy group and the non-neoadjuvant chemotherapy group. Demographic data and perioperative outcomes were compared between these 2 groups. RESULTS: Of the 110 patients who received double sleeve lobectomy during this period, 35 patients (31.8%) received neoadjuvant chemotherapy. Compared with the non-neoadjuvant chemotherapy group, patients who received neoadjuvant chemotherapy were associated with younger age (P = 0.026), smaller pathologic tumour size (P = 0.005), higher forced expiratory volume in 1 s (P = 0.007), higher forced expiratory volume in 1 s of predicted value (P = 0.005) and higher clinical stage (P < 0.001). In the neoadjuvant chemotherapy group, 18 patients (51.4%) attained a partial response and 17 patients (48.6%) achieved stable disease. The postoperative hospital stays (P = 0.042) and chest tube drainage duration (P = 0.030) were longer in the neoadjuvant chemotherapy group and other perioperative performances were similar between these 2 groups. No statistically significant difference was reported in postoperative complications and mortality between these 2 groups. CONCLUSIONS: The intraoperative performance and postoperative outcomes of double sleeve lobectomy following neoadjuvant chemotherapy were similar to direct surgery, indicating that double sleeve lobectomy after neoadjuvant chemotherapy is feasible and safe in central lung cancer involving both the pulmonary artery and bronchus.
Shimomura M, Ishihara S, Okada S
… +1 more, Inoue M
Interact Cardiovasc Thorac Surg
· 2022 Jul · PMID 35416955
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Robot-assisted thymectomy through a subxiphoid scopic approach can provide a good surgical view, similar to that of median sternotomy. We originally used the subxiphoid port only for the robotic scope to avoid instrument...Robot-assisted thymectomy through a subxiphoid scopic approach can provide a good surgical view, similar to that of median sternotomy. We originally used the subxiphoid port only for the robotic scope to avoid instrument collision with the assistant device. This approach, robotic subxiphoid-optical thymectomy, is advantageous for the safe and accurate dissection of the bilateral phrenic nerves and the left brachiocephalic vein, which are especially needed in extended thymectomy for patients with myasthenia gravis.
Naruka V, Zientara A, Hussein N
… +1 more, Punjabi PP
Interact Cardiovasc Thorac Surg
· 2022 Jul · PMID 35403678
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During the COVID-19 pandemic, performing a surgeon's duties has become challenging while adhering to social distancing mandates. To aid in the continuity of healthcare services, rapid implementation of digital communicat...During the COVID-19 pandemic, performing a surgeon's duties has become challenging while adhering to social distancing mandates. To aid in the continuity of healthcare services, rapid implementation of digital communication tools became a necessity. This is an account of experiences using digital communication platforms, namely Microsoft Teams and Zoom, for clinical and educative purposes in the field of Cardiothoracic Surgery in the UK. While enabling ongoing virtual clinical meetings, conferences and learning opportunities for residents with little face-to-face contact, are these digital communication platforms keeping us connected or isolated?
Interact Cardiovasc Thorac Surg
· 2022 Jul · PMID 35394531
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Failing Fontan patients present a unique challenge for mechanical circulatory support. We report on a 17-year-old patient with Fontan failure and preserved ventricular function who underwent mechanical cavopulmonary supp...Failing Fontan patients present a unique challenge for mechanical circulatory support. We report on a 17-year-old patient with Fontan failure and preserved ventricular function who underwent mechanical cavopulmonary support using a novel cannulation technique.
Laufer G, Strauch JT, Terp KA
… +5 more, Salinas M, Arribas JM, Massetti M, Andreas M, Young CP
Interact Cardiovasc Thorac Surg
· 2022 Jul · PMID 35394527
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OBJECTIVES: We report on real-world safety and performance outcomes of minimally invasive rapid-deployment aortic valve replacement using the EDWARDS INTUITY Elite aortic valve system. METHODS: The study valve system was...OBJECTIVES: We report on real-world safety and performance outcomes of minimally invasive rapid-deployment aortic valve replacement using the EDWARDS INTUITY Elite aortic valve system. METHODS: The study valve system was used in a European, prospective, multicentre post-market study. Various procedural, haemodynamic and clinical outcomes were evaluated through 6 months of post-implant. RESULTS: A total of 276 patients out of 280 (98.6%) enrolments were successfully implanted with the study valve using a minimally invasive approach between February 2016 and April 2017. Of these 276 patients, 240 (87%) underwent partial sternotomy and 36 (13%) patients underwent right thoracotomy. Mean cross-clamp time was 51.9 [standard deviation (SD): 16.0] min. From baseline to 6 months, the mean effective orifice area increased from 0.8 (SD: 0.3) to 1.8 (SD: 0.6) cm2 and the mean systolic gradient decreased from 46.0 (SD: 14.1) to 8.8 (SD: 3.7) mmHg. After 6 months, 70.7% and 26.4% of patients were in New York Heart Association class I and II, respectively. Freedom from death, major bleeding, major paravalvular leak, reoperation and device explant at 6 months were 96.0%, 98.5%, 98.8%, 99.2% and 99.2%, respectively. CONCLUSIONS: These results demonstrate that the study valve is a safe and effective choice for patients undergoing aortic valve replacement via minimally invasive surgery. NAME AND REGISTRATION OF REGISTRY: MISSION (Assessing clinical outcomes using the EDWARDS INTUITY Elite Valve System in isolated AVR using Minimally InvaSive Surgery In a EurOpean multi-ceNter, active, post-market registry). clinicaltrials.gov ID #NCT02907463.
Oishi H, Matsuda Y, Ejima Y
… +7 more, Toyama H, Hirama T, Watanabe T, Watanabe Y, Niikawa H, Noda M, Okada Y
Interact Cardiovasc Thorac Surg
· 2022 Jul · PMID 35394027
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OBJECTIVES: The objective of the present study was to examine the effect of venovenous (VV) extracorporeal membrane oxygenation (ECMO) use on the haemodynamics during single lung transplantation (SLT) and postoperative c...OBJECTIVES: The objective of the present study was to examine the effect of venovenous (VV) extracorporeal membrane oxygenation (ECMO) use on the haemodynamics during single lung transplantation (SLT) and postoperative course. METHODS: Forty-seven patients who underwent SLT for end-stage lung diseases in our lung transplant centre between January 2010 and December 2019 were included in this study. The recipients were divided into 3 groups according to the type of intraoperative ECMO. No type of ECMO was intra-operatively used in the patients of the no use of ECMO (NO ECMO) group. The patients in the venoarterial (VA) and VV ECMO groups were put on VA and VV ECMO during the surgery, respectively. The data were compared among the 3 groups. RESULTS: There were 13 SLT cases in the NO ECMO group, 23 SLT cases in the VA ECMO group and 11 SLT cases in the VV ECMO group. Re-exploration for bleeding was performed in 3 (13.0%) recipients in the VA ECMO group. No recipients required re-exploration in the other groups. In the NO ECMO group, systolic pulmonary arterial pressure (PAP) was significantly elevated during the main pulmonary artery clamp on the SLT side and it was decreased in the VA ECMO group because of the bypass flow. Interestingly, systolic PAP was significantly decreased in the VV ECMO group as well. CONCLUSIONS: VV ECMO decreases the PAP during SLT, which could be a choice for extracorporeal life support during lung transplant surgery for patients, even those with pulmonary hypertension.
Matsuyama K, Watanuki H, Tochii M
… +1 more, Sugiyama K
Interact Cardiovasc Thorac Surg
· 2022 Jul · PMID 35389491
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A 52-year-old man presented with temporal haemoptysis and chest pain 6 months after radiofrequency catheter ablation for atrial fibrillation. Computed tomography revealed severe stenosis in the left upper pulmonary vein...A 52-year-old man presented with temporal haemoptysis and chest pain 6 months after radiofrequency catheter ablation for atrial fibrillation. Computed tomography revealed severe stenosis in the left upper pulmonary vein (PV) and complete occlusion of the left lower PV. A modified sutureless repair of the left PV obstruction was successfully performed. This modified procedure provides a feasible, safe and effective means of treating PV obstruction, even in cases with distal extension of stenosis.
Interact Cardiovasc Thorac Surg
· 2022 Jul · PMID 35389488
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Granular cell tumours are usually benign with a 1-2% incidence of malignancy. They are less sensitive to radiotherapy and chemotherapy and are treated by surgical excision. We report a case of a malignant granular cell t...Granular cell tumours are usually benign with a 1-2% incidence of malignancy. They are less sensitive to radiotherapy and chemotherapy and are treated by surgical excision. We report a case of a malignant granular cell tumour located at the interventricular septum.
Interact Cardiovasc Thorac Surg
· 2022 Jul · PMID 35381086
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Doege Potter syndrome is a rare condition causing non-islet cell paraneoplastic hypoglycaemia associated with fibrous tumours, which can be both benign and malignant. The vast majority are solitary and located within the...Doege Potter syndrome is a rare condition causing non-islet cell paraneoplastic hypoglycaemia associated with fibrous tumours, which can be both benign and malignant. The vast majority are solitary and located within the chest. Non-islet cell tumour-induced hypoglycaemia, as in Doege Potter syndrome, is quite rare and occurs around 4 times less often than islet cell-associated paraneoplastic hypoglycaemia. We present a case of Doege Potter syndrome with severe hypoglycaemia in conjunction with multiple recurrent fibrous tumours of the lung and pleura.
Lorusso R, Heuts S, Jiritano F
… +18 more, Scrofani R, Antona C, Actis Dato G, Centofanti P, Ferrarese S, Matteucci M, Miceli A, Glauber M, Vizzardi E, Sponga S, Vendramin I, Garatti A, de Vincentis C, De Bonis M, Ajello S, Troise G, Dalla Tomba M, Serraino F
Interact Cardiovasc Thorac Surg
· 2022 Jun · PMID 35381083
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OBJECTIVES: Although the intra-aortic balloon pump (IABP) has been the most widely adopted temporary mechanical support device in cardiac surgical patients, its use has declined. The current study aimed to evaluate the o...OBJECTIVES: Although the intra-aortic balloon pump (IABP) has been the most widely adopted temporary mechanical support device in cardiac surgical patients, its use has declined. The current study aimed to evaluate the occurrence and predictors of early mortality and complication rates in contemporary cardiac surgery patients supported by an IABP. METHODS: A multicentre, retrospective analysis was performed of all consecutive cardiac surgical patients receiving perioperative balloon pump support in 8 centres between January 2010 to December 2019. The primary outcome was early mortality, and secondary outcomes were balloon-associated complications. A multivariable binary logistic regression model was applied to evaluate predictors of the primary outcome. RESULTS: The study cohort consisted of 2615 consecutive patients. The median age was 68 years [25th percentile 61, 75th percentile 75 years], with the majority being male (76.9%), and a mean calculated 30-day mortality risk of 10.0%. Early mortality was 12.7% (n = 333), due to cardiac causes (n = 266), neurological causes (=22), balloon-related causes (n = 5) and other causes (n = 40). A composite end point of all vascular complications occurred in 7.2% of patients, and leg ischaemia was observed in 1.3% of patients. The most important predictors of early mortality were peripheral vascular disease [odds ratio (OR) 1.63], postoperative dialysis requirement (OR 10.40) and vascular complications (OR 2.57). CONCLUSIONS: The use of the perioperative IABP proved to be safe and demonstrated relatively low complication rates, particularly for leg ischaemia. As such, we believe that specialists should not be held back to use this widely available treatment in high-risk cardiac surgical patients when indicated.