Prophylactic Implantation of Intra-aortic Balloon Counterpulsation in High-Risk Cardiac Surgery Patients: A Single-Center Experience

Background: Intra-aortic balloon pump (IABP) is a controversially discussed option to treat patients with heart failure. The overall impact and hereby also the prophylactic implantation of an IABP have decreased in recent years, but is still part of surgical practice. Therefore, the aim of this study was to investigate prophylactic implantation of an IABP on the outcome of high-risk patients from a single center.

Method: We analyzed a total of 487 patients from 2007 to 2020 with indication for surgical revascularization and highly reduced ejection fraction < 30%. 285 of them received preoperative IABP implantation. Patients were analyzed, assessing gender, risk profile, preoperative ejection fraction (EF), and complication rates in terms of mechanical circulatory support or 30-day mortality.

Results: Overall 30-day mortality was comparable in group 1 with preoperative IABP compared with group 2 without preoperative IABP (20.7 vs. 15.3%; n.s.). Mean age was 65.8 ± 9.5 (group 1) versus 65 ± 10.4 years (group 2; p = 0.37) with 84.2% male in group 1 versus 81.2% male in group 2. Mean EuroSCORE 2 was comparable in group 1 (9.95) compared with 9.75 in group 2 (p = 0.59). Rate of cardiogenic shock patients was slightly elevated in group 2 (19.8 vs. 17.2%) but did not reach statistical significance. Pre-op ejection fraction was not significantly different in both groups (21.5 vs. 22.2%; p = 0.23). However, perioperative requirement of VA-ECMO (group 1: 1.4% vs. group 2: 5.4%; p = 0.01) and switch to durable MCS (group 1: 7.4% vs. group 2: 23.8%; p < 0.01) was significantly different in both groups, while 30-day mortality was statistically not different (group 1: 20.7% vs. group 2:15.4%; p = 0.13).

Conclusion: Our analysis demonstrates that IABP support in high-risk patients may be an effective way to treat patients with reduced LV function preoperatively. The significant better results in terms of MCS support may also be attributed to a selection bias and a slightly higher rate of cardiogenic shock patients in the no-IABP group, which ultimately may have driven surgeons to a more definitive surgical strategy with VAD implantation instead of high risk CABG. The prophylactic implantation of IABP should still be taken into account and should consider clinical conditions.

Publication History

Article published online:
03 February 2022