Outcomes of preoperative intra-aortic balloon pump insertion in high-risk coronary artery bypass grafting: A decade of single-centre experience

Background The role of prophylactic preoperative intra-aortic balloon pump (IABP) in patients undergoing coronary artery bypass grafting (CABG) remains uncertain. This study aims to evaluate the safety and outcomes of preoperative IABP insertion in high-risk CABG patients. Methods A retrospective review of outcomes of patients who had preoperative IABP insertion undergoing isolated CABG at a single United Kingdom quaternary centre was conducted between January 2015 and June 2025. Indications for IABP insertion were divided into prophylactic (critical coronary anatomy) and non-prophylactic insertion (haemodynamic instability and persistent angina). Primary outcome was 30-day mortality, and secondary outcomes included 90-day mortality, incidence of postoperative complications, specific complications related to IABP insertion and postoperative length of stay. Comparative analysis was performed between the two groups. Kaplan-Meier survival analyses were performed. Results 610 patients underwent isolated CABG with preoperative IABP; 302 (49.5%) received prophylactic IABP and 308 (50.5%) had non-prophylactic insertion. There were 14 (2.3%) 30-day mortality and 20 (3.3%) 90-day mortality, with no significant difference in mortality between the two groups. Mean postoperative length of hospital stay was 11 ± 7 days; this was significantly longer in the non-prophylactic group (12 ± 8 vs 10 ± 7 days, p < 0.01). Postoperative neurological dysfunction occurred in 42 patients (6.9%) and dialysis in 5 (0.8%), with no differences between the two groups. There were 25 (4.1%) IABP-related complications; 8 localised haematoma managed conservatively, 4 wound infections treated with intravenous antibiotics, 5 lower limb ischaemia (3 required surgical re-vascularisation), 2 fatal bowel ischaemia, 2 renal and splenic malperfusion, 2 localised femoral artery dissection and 2 retroperitoneal haematoma (1 required emergency laparotomy). Conclusion This study supports the selective use of prophylactic IABP in patients undergoing high-risk CABG. In this selected cohort, preoperative IABP use was associated with low early mortality, favourable long-term survival and an acceptable complication profile.