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Updated: Dec 3, 2025
The Intra-Aortic Balloon Pump
Published on: February 5, 2021
Preoperative Intra-Aortic Balloon Pumps in Cardiac Surgery: A Propensity Score Analysis
Umar S Ali1, Nick S R Lan2, Molly Gilfillan1
1Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, WA, Australia.
Insights
Intra-aortic balloon pump (IABP) use before coronary artery bypass graft (CABG) surgery in high-risk patients is linked to higher mortality and complications. Further randomized trials are needed to confirm these findings for IABP in CABG patients.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Medical Devices
Background:
- The utility of intra-aortic balloon pumps (IABP) in high-risk patients undergoing coronary artery bypass graft (CABG) surgery is debated.
- This study reports a 5-year experience from a new Australian center to address this controversy.
Purpose of the Study:
- To evaluate the impact of preoperative intra-aortic balloon pump (IABP) use on outcomes in patients undergoing urgent isolated coronary artery bypass graft (CABG) surgery.
- To identify specific adverse events associated with IABP use in this patient cohort.
Main Methods:
- Retrospective analysis of 690 patients undergoing urgent isolated CABG from February 2015 to May 2020.
- Propensity score adjustment was used to compare outcomes between patients with and without preoperative IABP use.
- Primary outcome was 30-day mortality; secondary outcomes included in-hospital complications.
Main Results:
- Preoperative IABP was utilized in 11.3% of patients.
- Adjusted analysis revealed significantly higher 30-day mortality in the IABP group (7.0% vs 2.0%, OR 6.03, p=0.002), particularly in patients with reduced ejection fraction or left main disease.
- IABP use was associated with increased red blood cell transfusions, prolonged inotrope use, extended mechanical ventilation, mesenteric ischemia, and multisystem organ failure.
Conclusions:
- Preoperative IABP use in isolated CABG surgery is associated with increased 30-day mortality and a higher incidence of adverse postoperative outcomes.
- The findings suggest a potential detrimental effect of IABP in this specific surgical context.
- Large-scale randomized controlled trials are warranted to definitively establish the role and safety of IABP in high-risk CABG patients.
Introduction:
The role of intra-aortic balloon pumps (IABP) in high-risk patients undergoing coronary artery bypass graft (CABG) surgery remains controversial. We report the 5-year experience from a new Australian centre.
Methods:
We retrospectively analysed 690 patients undergoing urgent isolated CABG surgery at a Western Australian tertiary centre from February 2015 to May 2020. De-identified data was obtained from the Australia & New Zealand Society of Cardiothoracic Surgeons database. Patients were stratified according to preoperative IABP use. A propensity score was created for the probability of IABP use and a propensity adjusted analysis was performed using logistic regression. The primary outcome was 30-day mortality. Secondary outcomes were postoperative inhospital outcomes.
Results:
Preoperative IABP was used in 78 patients (11.3%). After propensity score adjustment, in a subgroup of patients with reduced ejection fraction or left main disease, 30-day mortality (7.0% vs 2.0%, OR 6.03, 95% CI 1.89-19.28, p=0.002) was significantly higher in the IABP group. Red blood cell transfusions (19.7% vs 12.6%, OR 1.86, 95% CI 1.02-3.35, p=0.039), prolonged inotrope use (78.9% vs 50.9%, OR 6.11, 95% CI 2.77-13.48, p<0.001), prolonged invasive ventilation (28.2% vs 3.4%, OR 20.2, 95% CI 8.24-49.74, p<0.001), mesenteric ischaemia (2.8% vs 0%, OR 4.52, 95% CI 1.15-17.77, p=0.031) and multisystem organ failure (1.3% vs 0.7%, OR 25.68, 95% CI 2.55-258.34, p=0.006) were significantly higher in the IABP group.
Conclusion:
In patients undergoing isolated CABG surgery, preoperative IABP use was associated with increased 30-day mortality and adverse outcomes. Large randomised controlled trials are required to confirm our findings.
