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Updated: May 12, 2026
The Intra-Aortic Balloon Pump
Published on: February 5, 2021
Prophylactic IABP in patients with severe ventricular dysfunction undergoing CABG: impact on early postoperative
Laura Asta1,2, Stefano Guarracini3, Matteo Perfetti4
1Department of Neuroscience, Imaging and clinical Sciences, Cardiac Surgery Dept, University "G.d'Annunzio" Chieti & Pescara, Via dei Vestini, Chieti, 66100, Italy. laura.asta@unich.it.
Insights
Prophylactic use of intra-aortic balloon pumps (IABP) before coronary artery bypass grafting (CABG) in patients with low ejection fraction did not significantly reduce 30-day mortality or postoperative complications.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Devices
Background:
- Intra-aortic balloon pump (IABP) provides mechanical hemodynamic support in cardiogenic shock.
- The prophylactic use of IABP before coronary artery bypass grafting (CABG) in patients with severe ventricular dysfunction but without critical conditions is debated.
Purpose of the Study:
- To evaluate the effectiveness of prophylactic preoperative intra-aortic balloon pump (IABP) use in patients with left ventricular ejection fraction (LVEF) < 30% undergoing CABG.
Main Methods:
- Retrospective analysis of 16,222 patients undergoing CABG with LVEF < 30%.
- Propensity score matching (PSM) 1:1 for 634 patients receiving prophylactic preoperative IABP versus those not receiving it.
- Doubly robust logistic regression and sensitivity analyses based on surgical technique (off-pump vs. on-pump).
Main Results:
- After PSM, 557 pairs were analyzed. No significant differences in 30-day mortality (7.0% vs. 4.1%) between IABP and no-IABP groups.
- Secondary outcomes including CVA, dialysis, re-exploration for bleeding, and deep sternal wound infection (DSWI) also showed no significant differences.
- Sensitivity analyses stratified by surgical technique did not reveal significant associations, though off-pump subgroup estimates were imprecise.
Conclusions:
- Prophylactic preoperative IABP use in patients with LVEF < 30% undergoing CABG is not associated with a significant reduction in early mortality.
- The study found no significant association between prophylactic IABP and major postoperative complications after risk adjustment.
Background:
The mechanical hemodynamic support provided by IABP placement is recognized in cases of cardiogenic shock or severe clinical compromise. The benefits of its prophylactic use before CABG in patients with severe ventricular dysfunction but in the absence of critical conditions remain controversial.
Method:
We conducted a retrospective analysis by NACSA of 16,222 patients with LVEF < 30% indicated for CABG in the absence of clinical emergencies between 1996 and 2018. 634 underwent prophylactic preoperative IABP and were matched 1:1 using PSM with patients not receiving IABP. Of these, 634 patients received preoperative prophylactic IABP. PSM (1:1) was performed, followed by doubly robust logistic regression analysis. The primary outcome was 30-day mortality. Secondary outcomes included postoperative CVA, postoperative dialysis, re-exploration for bleeding, and DSWI. Finally, a sensitivity analysis was conducted stratifying the population based on the surgical technique used: off-pump or on-pump.
Results:
After matching, 557 pairs of patients were analyzed. No significant differences were observed between groups in 30-day mortality (7.0% vs. 4.1%; OR 1.65, 95% CI 0.98-2.71; p = 0.058) or in secondary outcomes, including CVA (OR 0.74, 95% CI 0.23-2.12; p = 0.62), dialysis (OR 1.39, 95% CI 0.84-2.38; p = 0.16), re-exploration for bleeding (OR 1.15, 95% CI 0.85-2.01; p = 0.43), and DSWI (OR 1.39, 95% CI 0.41-4.38; p = 0.49). These findings were consistent in doubly robust analyses. Sensitivity analyses stratified by surgical technique showed no significant associations, although estimates in the off-pump subgroup were imprecise.
Conclusions:
Prophylactic preoperative IABP use was not associated with a significant reduction in early mortality or major postoperative complications after adjustment for baseline risk.
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