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Updated: Jun 12, 2026
The Intra-Aortic Balloon Pump
Published on: February 5, 2021
Perioperative heart failure in coronary surgery and timing of intra-aortic balloon pump insertion
M Ranucci1, A Ballotta, S Castelvecchio
1Department of Cardiothoracic - Vascular Anesthesia and Intensive Care, IRCCS Policlinico S.Donato, Milan, Italy. cardioanestesia@virgilio.it
Insights
Early use of intra-aortic balloon pumps (IABP) in patients with perioperative heart failure after coronary surgery significantly reduces operative mortality compared to delayed IABP insertion. Prompt IABP use is crucial for better outcomes in high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Cardiac Surgery Outcomes
Background:
- Perioperative heart failure (HF) following coronary operations is associated with high mortality.
- Intra-aortic balloon pump (IABP) is a common treatment for this condition.
- Optimal timing for IABP insertion in these patients remains unclear.
Purpose of the Study:
- To investigate the impact of early versus late IABP insertion on operative mortality in patients with perioperative HF undergoing coronary surgery.
Main Methods:
- Retrospective analysis of 7,270 patients undergoing coronary surgery.
- Identification of 1,051 patients with perioperative HF.
- Comparison of outcomes between early (intra-operative) IABP use and late (post-operative) IABP use for drug-refractory HF.
Main Results:
- Perioperative HF occurred in 14.5% of patients, with an overall mortality of 13.5%.
- Operative mortality was significantly higher in patients receiving late IABP insertion (64.4%) compared to early IABP insertion (41.5%) (P=0.001).
- Independent risk factors for drug-refractory HF included age, pre-operative creatinine, and mitral valve procedures.
Conclusions:
- Delayed IABP use in drug-refractory heart failure may be detrimental.
- Early IABP insertion is recommended, especially in patients with identified risk factors for refractory HF.
Background:
Perioperative heart failure (HF) in coronary operations is accompanied by a high operative mortality rate. An intra-aortic balloon pump (IABP) is often used to treat this syndrome. The correct timing for IABP insertion after completion of the operation has not yet been investigated. The aim of this study was to investigate the operative mortality in perioperative HF patients who had undergone coronary operations with respect to the early or the late use of IABP.
Methods:
This is a retrospective study including 7,270 patients who had undergone coronary surgery with or without associated procedures. A population of patients with perioperative HF was extracted and analyzed with respect to the use of drugs, intra-operative or post-operative IABP to treat this condition.
Results:
A total of 1,051 (14.5%) patients had perioperative HF. The mortality rate in this group was 13.5%. Early (intra-operative) IABP insertion was performed in 123 patients. In contrast, 928 patients were treated with inotropic drugs only, and, of these patients, 59 developed a drug-refractory HF requiring late IABP insertion. Operative mortality was significantly (P=0.001) higher in patients requiring late (64.4%) vs. early (41.5%) IABP insertion. Independent risk factors for developing a drug-refractory HF were age, pre-operative serum creatinine value and an associated mitral valve procedure.
Conclusions:
Postponing the use of IABP may be deleterious in patients with drug-refractory HF. In the presence of the three factors independently associated with the risk of a drug-refractory HF, early IABP insertion is suggested.
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