Prophylactic intra-aortic balloon pump in gastrointestinal cancer surgery: a potential approach to mitigate perioperative ischemic risk in severe coronary artery disease

Patients with severe coronary artery disease (CAD) requiring time-sensitive gastrointestinal cancer surgery face a dual challenge: perioperative myocardial ischemia and surgical bleeding. The optimal management strategy in this setting remains undefined. This single-center retrospective cohort study evaluated the association between prophylactic intra-aortic balloon pump (IABP) placement and perioperative outcomes in 100 patients with angiographically confirmed severe CAD who underwent gastrointestinal cancer surgery between February 2014 and May 2024. Fifty patients received preoperative prophylactic IABP, and 50 served as controls. The primary combined endpoint was perioperative major adverse cardiovascular events (MACE) and all-cause mortality. Secondary outcomes included major bleeding and intensive care unit admission. As a post-hoc sensitivity analysis, propensity score matching (1:1 nearest neighbor, caliper 0.02) was performed based on the number of diseased vessels to further explore the robustness of the findings. Prophylactic IABP significantly outperformed conventional management in terms of reducing the primary combined endpoint (4.0% vs. 32.0%, P < 0.001). This reduction was primarily driven by a lower incidence of perioperative myocardial infarction (4.0% vs. 22.0%, P = 0.017). In the propensity score matching sensitivity analysis, the composite endpoint remained lower in the IABP group (2.9% vs. 37.1%, P = 0.001). Major bleeding events were less frequent in the IABP group before matching (6.0% vs. 22.0%, P = 0.041), but this difference did not persist after matching ( P = 0.102). No significant difference was found in the rates of ICU admission between the two groups ( P = 0.419). In this exploratory retrospective cohort, prophylactic IABP placement was associated with lower rates of perioperative MACE in patients with severe CAD undergoing gastrointestinal cancer surgery. The association with major bleeding was not robust after confounder adjustment. IABP may represent a potential circulatory support strategy for myocardial protection in this high-risk population, although further prospective studies are warranted to confirm these observations.