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Updated: Jun 26, 2026
The Intra-Aortic Balloon Pump
Published on: February 5, 2021
Preoperative intraaortic balloon pumping improves outcomes for high-risk patients in routine coronary artery bypass
Giuseppe Santarpino1, Francesco Onorati, Antonino S Rubino
1Cardiac Surgery Unit, Magna Graecia University, Catanzaro, Italy.
Insights
Preoperative intraaortic balloon pumping in high-risk coronary artery bypass grafting patients is associated with outcomes comparable to low-risk patients. This intervention appears to effectively reduce the perceived risk category for these complex surgical cases.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Interventional Cardiology
Background:
- Coronary artery bypass grafting (CABG) carries significant risks for high-risk patients.
- Preoperative optimization strategies are crucial for improving outcomes in complex cardiac surgeries.
Purpose of the Study:
- To evaluate the association between preoperative intraaortic balloon pumping (IABP) and in-hospital and long-term outcomes in high-risk patients undergoing CABG.
- To compare outcomes of high-risk patients receiving preoperative IABP with those of low-risk patients not receiving IABP.
Main Methods:
- A retrospective study comparing 111 high-risk patients (European System for Cardiac Operative Risk Evaluation [EuroSCORE] ≥ 12) who received preoperative IABP with 130 low-risk patients (EuroSCORE ≤ 5) who did not.
- Clinical, biochemical, and echocardiographic data were collected up to 1 year post-surgery.
- Key outcomes assessed included mortality, myocardial damage, and functional recovery.
Main Results:
- High-risk patients receiving IABP were older with more comorbidities and lower ejection fraction.
- Perioperative troponin leakage and intraoperative data were comparable between groups.
- In-hospital mortality, perioperative myocardial damage, and hospital stay duration were similar.
- High-risk patients showed significant improvement in ejection fraction post-surgery.
- Long-term outcomes, including death, recurrent angina, and repeat procedures, did not differ significantly.
Conclusions:
- Preoperative IABP effectively shifts high-risk CABG patients into a lower-risk category.
- The use of IABP is associated with comparable perioperative myocardial damage and similar short- and long-term outcomes compared to low-risk patients not receiving IABP.
Background:
We evaluated the association between the preoperative use of intraaortic balloon pumping and in-hospital and long-term outcomes in high-risk patients undergoing coronary artery bypass grafting.
Methods:
From 714 total patients undergoing coronary artery bypass grafting during a 4-year period, we compared the clinical, biochemical, and echocardiographic findings up to 1 year after surgery between 111 patients who had a European System for Cardiac Operative Risk Evaluation (EuroSCORE) of 12 or greater and received intraaortic balloon pumping preoperatively (group A) and 130 patients who had a EuroSCORE of 5 or less and received no preoperative intraaortic balloon pumping (group B).
Results:
Group A patients were significantly older, had significantly more comorbid conditions, and had a significantly lower mean preoperative ejection fraction (all p < 0.001). Intraoperative data were comparable between groups, as were lactate and troponin I levels sampled from the coronary sinus. Lactate, troponin I, creatine kinase, and creatine kinase-MB mass showed comparable leakage at all postoperative times. The incidences of in-hospital mortality, perioperative myocardial damage, and acute myocardial infarction and duration of hospital stay were comparable. High-risk patients showed significant improvements in ejection fraction (p < 0.001) and wall-motion score index (p = 0.06) after surgery, but low-risk patients showed no significant change in these variables. The incidences of death, recurrent angina, myocardial infarction, and repeat coronary procedures did not differ significantly between groups.
Conclusions:
The preoperative use of intraaortic balloon pumping appears to shift high-risk patients undergoing coronary artery bypass grafting into a lower-risk category and is associated with comparable perioperative troponin leakage and short-term and long-term outcomes similar to low-risk patients not receiving intraaortic balloon pumping.
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