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Updated: May 9, 2026
The Intra-Aortic Balloon Pump
Published on: February 5, 2021
A randomized controlled trial of preoperative intra-aortic balloon pump in coronary patients with poor left
Marco Ranucci1, Serenella Castelvecchio, Andrea Biondi
11Department of Cardiothoracic-Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy. 2Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy.
Insights
Preoperative intra-aortic balloon pump use did not improve outcomes in high-risk patients undergoing coronary operations. The procedure is not justified due to potential complications and costs.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Critical Care Medicine
Background:
- Debate exists regarding the efficacy of preoperative intra-aortic balloon pump (IABP) use in high-risk cardiac surgery patients.
- High-risk patients often have reduced left ventricular ejection fraction (LVEF), increasing perioperative morbidity.
Purpose of the Study:
- To evaluate the impact of preoperative IABP on outcomes in high-risk patients undergoing coronary artery bypass grafting (CABG).
- To determine if IABP improves major morbidity and mortality in patients with LVEF < 35%.
Main Methods:
- A single-center prospective randomized controlled trial was conducted.
- 110 patients with LVEF < 35% undergoing elective CABG were randomized to receive preincision IABP or no intervention.
- Primary outcome was the composite rate of major postoperative morbidity.
Main Results:
- No significant difference in major morbidity rate was observed between the IABP group (40%) and the control group (31%).
- No differences in cardiac index were noted pre- or post-operatively.
- The IABP group showed lower mean systemic arterial pressure and required less dopamine infusion postoperatively.
Conclusions:
- Preincision IABP does not improve outcomes in hemodynamically stable, high-risk patients undergoing elective coronary operations.
- The risks, complications, and costs associated with IABP insertion outweigh potential benefits in this patient population.
- Current evidence does not support routine preoperative IABP use in selected high-risk cardiac surgery patients.
Objective:
Preoperative intra-aortic balloon pump use in high-risk patients undergoing surgical coronary revascularization is still a matter of debate. The objective of this study is to determine whether the preoperative use of an intra-aortic balloon pump improves the outcome after coronary operations in high-risk patients.
Design:
Single-center prospective randomized controlled trial.
Setting:
Tertiary cardiac surgery center, research hospital.
Patients:
One hundred ten subjects undergoing coronary operations, with a poor left ventricular ejection fraction (< 35%) and no hemodynamic instability.
Interventions:
Patients randomized to receive preincision intra-aortic balloon pump or no intervention.
Measurements And Main Results:
The primary outcome measurement was postoperative major morbidity rate, defined as one of prolonged mechanical ventilation, stroke, acute kidney injury, surgical revision, mediastinitis, and operative mortality. There was no difference in major morbidity rate (40% in intra-aortic balloon pump group and 31% in control group; odds ratio, 1.49 [95% CI, 0.68-3.33]). No differences were observed for cardiac index before and after the operation; at the arrival in the ICU, patients in the intra-aortic balloon pump group had a significantly (p = 0.01) lower mean systemic arterial pressure (80.1 ± 15.1 mm Hg) versus control group patients (89.2 ± 17.9 mm Hg). Fewer patients in the intra-aortic balloon pump group (24%) than those in the control group (44%) required dopamine infusion (p = 0.043).
Conclusions:
This study demonstrates that in patients undergoing nonemergent coronary operations, with a stable hemodynamic profile and a left ventricular ejection fraction less than 35%, the preincision insertion of intra-aortic balloon pump does not result in a better outcome. Given the possible complications of intra-aortic balloon pump insertion, and the additional cost of the procedure, this approach is not justified.
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