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Updated: May 23, 2026
The Intra-Aortic Balloon Pump
Published on: February 5, 2021
Preoperative intra-aortic balloon pump in high-risk coronary bypass grafting
Edward Litton1, Anthony Delaney
1Intensive Care Unit, Royal Perth Hospital, Western Australia. ed.litton@health.wa.gov.au
Insights
Prophylactic intra-aortic balloon pumping before coronary artery bypass grafting in high-risk patients showed no significant association with 30-day mortality. However, a potential reduction in mortality could not be ruled out.
Area of Science:
- Cardiac Surgery
- Cardiovascular Medicine
- Medical Technology
Background:
- Prophylactic intra-aortic balloon pumping (IABP) use before coronary artery bypass grafting (CABG) varies despite supporting evidence.
- High-risk patients undergoing CABG represent a significant proportion of cases with increased postoperative mortality risk.
Purpose of the Study:
- To characterize high-risk patients undergoing CABG.
- To examine preoperative IABP utilization in this cohort.
- To determine the association between preoperative IABP and 30-day mortality.
Main Methods:
- Retrospective analysis of the Australian National Cardiac Surgery Database (8-year period).
- Inclusion of 18,662 patients undergoing CABG, with 2,348 identified as high-risk.
- Primary outcome: 30-day mortality adjusted for preoperative illness severity.
Main Results:
- 15.3% of high-risk patients received preoperative IABP (359/2,348).
- Unadjusted 30-day mortality was higher in high-risk patients with IABP (15.3%) versus without (4.9%).
- After adjusting for illness severity, no significant association was found between preoperative IABP and 30-day mortality.
Conclusions:
- A small minority of high-risk CABG patients receive preoperative IABP.
- Preoperative IABP was not significantly associated with 30-day mortality after adjusting for illness severity.
- A potential 20% reduction in mortality with IABP cannot be excluded, warranting further investigation.
Abstract:
Prophylactic intra-aortic balloon pumping prior to coronary artery bypass grafting is employed variably despite some evidence to support its use. The aim of this study was to describe the characteristics, preoperative balloon pump utilization, and outcomes of high-risk patients undergoing coronary artery bypass. The study cohort included all patients in the Australian National Cardiac Surgery Database over an 8 year period. The primary outcome was 30-day mortality adjusted for preoperative illness severity. Coronary artery bypass was performed in 18,662 patients including 2,348 (12.6%) identified as high-risk. Of these high-risk patients, 359 (15.3%) received a balloon pump preoperatively. For high-risk patients, 30-day mortality was significantly higher in those with a preoperative balloon pump than in those who did not receive a preoperative balloon pump (15.3% vs. 4.9%). After adjusting for preoperative illness severity, there was no significant association between preoperative balloon pumping and 30-day mortality. High-risk patients represent a significant proportion of those undergoing coronary artery bypass grafting. Despite their increased risk of postoperative mortality, only a small minority currently receive a preoperative balloon pump. After adjusting for illness severity, there was no significant association between preoperative balloon pumping and 30-day mortality, although we could not rule out a 20% reduction in mortality.
