Impact of Prophylactic Preoperative Intra-Aortic Balloon Pump on Early Outcome in Patients with Severe Left Ventricular Dysfunction Undergoing Elective On-Pump Coronary Artery Bypass Grafting

Background: The aim of this study was to analyze whether prophylactic preoperative intra-aortic balloon pump (IABP) improves early outcomes in hemodynamically stable patients with low left ventricular ejection fraction (LVEF ≤ 30%) undergoing elective myocardial revascularization using cardiopulmonary bypass (on-pump CABG). Secondary aim was to identify the predictors for low cardiac output syndrome (LCOS).

Method: From January 2009 to December 2019, a total of 207 consecutive patients with LVEF ≤ 30% who underwent elective isolated on-pump CABG were enrolled in this study. Early outcomes of 136 patients with prophylactic IABP inserted 12 to 24 hours before surgery (IABP group) and 71 patients without IABP (control group) were evaluated retrospectively. Patients with prophylactic preoperative IABP were matched 1:1 with patients without prophylactic IABP by a propensity score matching. Stepwise logistic regression was conducted to identify predictors of postoperative LCOS in the propensity-matched cohort. P value ≤0.05 was considered statistically significant.

Results: The patients in both groups did not differ statistically in terms of in-hospital mortality, even if the control group showed a trend toward higher mortality (4.2 vs. 9.9%, p = 0.325). Reduced postoperative LCOS (5.6 vs. 26.8%, p = 0.001) and cardiac surgery-associated acute kidney injury (12.7 vs. 32.4%, p = 0.009) were observed in patients receiving prophylactic preoperative IABP. Stepwise logistic regression identified preoperative IABP as preventive factor for postoperative LCOS (odds ratio [OR] 0.08, 95% confidence interval (CI), 0.02–0.28, p < 0.001). Independent predictor for LCOS was preoperative renal failure (OR: 3.38, 95% CI: 1.14–10.24, p = 0.028). There were no major IABP-related complications.

Conclusion: This study suggests that elective patients with left ventricular ejection fraction ≤30% undergoing on-pump CABG benefit from prophylactic preoperative IABP insertion. In contrast to other relevant studies, the observed beneficial effects might be attributed to longer preoperative IABP pumping (pulsation) times.

Publication History

Article published online:
28 January 2023