Benefits of the Preemptive Intra-Aortic Balloon Pump: An Audit of Practice in a Regional Cardiothoracic Center


  • Nnamdi Nwaejike
  • Gianfranco Campalani
  • Dennis Gladstone
  • O. C. Nzewi



Background: Recent evidence suggests that preemptive use of an intra-aortic balloon pump (IABP) is associated with better outcomes in high-risk patients undergoing cardiac surgery. This retrospective study compares preemptive (planned) use of the IABP to emergency (unplanned) use in a regional cardiothoracic center.

Methods: All patients who required an IABP from February 2003 to June 2006 were identified from theater records. The collected data included patient demographics, preoperative state, operative details, morbidity due to the IABP, and operative mortality. Patients were divided into 2 groups: planned use (preoperative plus elective intraoperative) and unplanned use (postoperative plus emergency intraoperative). Preoperative mortality risk was calculated with the logistic EuroSCORE.

Results: We identified 135 patients (75% male). There were no significant differences between the groups with respect to age, preoperative state, operation type, logistic EuroSCORE, or myocardial ischemia time. The 2 groups showed a significant difference in mortality: planned IABP insertion, 17%; unplanned insertion, 45% (P = .001). A multivariate analysis of the study population showed the logistic EuroSCORE (odds ratio, 0.974; 95% confidence interval, 0.950-0.998; P = .035) and timing of IABP use (odds ratio, 4.728; 95% confidence interval, 1.932-11.566; P = .001) to be independent predictors of mortality.

Conclusion: Preemptive use of the IABP in this patient cohort was associated with a 50% advantage in mortality compared with emergency IABP use. The logistic EuroSCORE may be used preoperatively to guide IABP use. Complications are rare and can be treated successfully. The risk-to-benefit ratio of preemptive IABP use is low in this cohort of patients.


Arafa O, Pedersen T, Svennevig JL, Fosse E, Geiran OR. 1999. Vascular complications of the intraaortic balloon pump in patients undergoing open heart operations: 15-year experience. Ann Thorac Surg 67:645-51.nBaskett R, Ghali WA, Maitland A, Hirsch GM. 2002. The intraaortic balloon pump in cardiac surgery. Ann Thorac Surg 74:1276-87.nBiancari F, Kangasniemi O, Luukkonen J, et al. 2006. EuroSCORE predicts immediate and late outcome after coronary artery bypass surgery. Ann Thorac Surg 82:57-61.nChristenson J, Badel P, Simonet F, Schmuziger M. 1997. Preoperative intraaortic balloon pump enhances cardiac performance and improves the outcome of redo CABG. Ann Thorac Surg 64:1237-44.nChristenson JT, Cohen M, Ferguson J 3rd, et al. 2002. Trends in intraaortic balloon counterpulsation complications and outcomes in cardiac surgery. Ann Thorac Surg 74:1086-91.nChristenson J, Simonet F, Badel P, Schmuziger M. 1997. Evaluation of preoperative intra-aortic balloon pump support in high risk coronary patients. Eur J Cardiothorac Surg 11:1097-103.nChristenson J, Simonet F, Badel P, Schmuziger M. 1999. Optimal timing of preoperative intraaortic balloon pump support in high-risk coronary patients. Ann Thorac Surg 68:934-9.nDietl CA, Berkheimer MD, Woods EL, Gilbert CL, Pharr WF, Benoit CH. 1996. Efficacy and cost-effectiveness of preoperative IABP in patients with ejection fraction of 0.25 or less. Ann Thorac Surg 62:401-9.nDyub AM, Whitlock RP, Abouzahr LL, Cinà CS. 2008. Preoperative intra-aortic balloon pump in patients undergoing coronary bypass surgery: a systematic review and meta-analysis. J Card Surg 23:79-86.nFerguson J 3rd, Cohen M, Freedman RJ Jr, et al. 2001. The current practice of intra-aortic balloon counterpulsation: results from the Benchmark Registry. J Am Coll Cardiol 38:1456-62.nGutfinger DE, Ott RA, Miller M, et al. 1999. Aggressive preoperative use of intraaortic balloon pump in elderly patients undergoing coronary artery bypass grafting. Ann Thorac Surg 67:610-3.nHealy DG, Veerasingam D, Wood AE. 2006. EuroSCORE: useful in directing preoperative intra-aortic balloon pump placement in cardiac surgery? Heart Surg Forum 9:E893-6.nHolman WL, Li Q, Kiefe CI, et al. 2000. Prophylactic value of preincision intra-aortic balloon pump: analysis of a statewide experience. J Thorac Cardiovasc Surg 120:1112-9.nKim KB, Lim C, Ahn H, Yang JK. 2001. Intraaortic balloon pump therapy facilitates posterior vessel off-pump coronary artery bypass grafting in high-risk patients. Ann Thorac Surg 71:1964-8.nMeharwal Z, Trehan N. 2002. Vascular complications of intra-aortic balloon insertion in patients undergoing coronary revascularization: analysis of 911 cases. Eur J Cardiothorac Surg 21:741-7.nNashef S, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. 1999. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 16:9-13.nNwaejike N, Bonde P, Campalani G. 2008. Complete mechanical circulatory support using ventricular assist devices for post-cardiotomy biventricular failure. Ulster Med J 77:36-8.nRoques F, Michel P, Goldstone A, Nashef S. 2003. The logistic EuroSCORE. Eur Heart J 24:881-2.nToumpoulis IK, Anagnostopoulos CE, Toumpoulis SK, DeRose JJ Jr, Swistel DG. 2005. EuroSCORE predicts long-term mortality after heart valve surgery. Ann Thorac Surg 79:1902-8.nWestaby S, Balacumaraswami L, Sayeed R. 2007. Maximizing survival potential in very high risk cardiac surgery. Heart Fail Clin 3:159-80.n



How to Cite

Nwaejike, N., Campalani, G., Gladstone, D., & Nzewi, O. C. (2009). Benefits of the Preemptive Intra-Aortic Balloon Pump: An Audit of Practice in a Regional Cardiothoracic Center. The Heart Surgery Forum, 12(2), E70-E74.