The use of Intra Aortic Balloon Pump in Coronary Artery Bypass Graft Surgery

Introduction: Intra-aortic balloon pump (IABP) is a mechanical device that increases cardiac output by increasing diastolic blood flow to the coronary arteries and lowers the afterload of the left ventricle in systole. IABP is primarily used in acute heart failure, that includes patients that have to undergo coronary artery bypass grafting (CABG). Its usage, however, in cardiac surgery has been declining with ongoing controversy regarding its benefits. The aim of this study was to assess the use and indications and outcome of IABP related to CABG surgery. Material and Methods: The study was retrospective and included 2177 patients that underwent CABG at Landspitali during 2001-2018. We compared those who received an IABP with controls, using uni- and multivariate analysis. Long term survival and complications (major adverse cardiovascular and cerebral events, MACCE) was estimated with Kaplan-Meier method. Results: A total of 99 (4.5%) patients received an IABP. The incidence was highest in 2006 (8.9%) and lowest in 2001 (1.7%), but the incidence did not change during the study period (p=0.90). Most patients received the pump before (58.6%) or during (34.3%) CABG, but only 6.1% after surgery. Complication rate was 14.1%, with bleeding from the insertion site in the groin being the most common complication. Thirty day mortality was higher in the IABP group compared with controls (22.2% vs 1.3%, p<0.001) and both 5-year survival (56.4% vs 91.5%, 95% CI: 0.47-0.67) and 5-year MACCE-free survival (46.9% vs 83.0%, 95% CI: 0.38-0.58) were inferior. Conclusions: Less than 5% of patients received IABP in relation to CABG in Iceland and the rate hasn't changed much for the last 18 years. Both the complication rate and 30-day mortality was higher in patients in IABP group and both the long term and MACCE-free survival was much worse, probably mostly related to worse overall clinical condition of the patient that received IABP.