Reply

We would like to thank the author for his interest in our article and for his constructive comments. Indeed, the discussion about the optimal timing and the definitive benefit of IABP therapy of high-risk patients who need surgical revascularization, particularly with ongoing acute myocardial infarction, is still ongoing. Concerning the timing of IABP implantation, our results are restricted by the heterogeneous structure of the investigated patients. Moreover, the retrospective character of our analysis contributes to an inclusion bias resulting in an unequal distribution of sick patients in both groups. However, the main target of our study was to find out the impact of IABP treatment on long-term survival in these patients at risk. We were able to confirm an acceptable 5-year survival rate for this critical population, irrespectively of the timing of implantation. Thus, we hypothesized that it is not the timing of therapeutical IABP implantation that determines the survival, but the use of the IABP itself. Finally, the impact of preoperative IABP support needs to be confirmed by prospective, randomized studies which, however, are strongly limited by restricted availability of appropriate patients and ethical concerns.