843 Do Preoperative Balloon Pumps Really Make a Difference?

Abstract

Intra-aortic balloon pumps are commonly used in patients with low cardiac output states undergoing cardiac surgery. Their benefit, however, remains controversial. This study aimed to evaluate the benefit of perioperative IABP use in these patients. A retrospective analysis of patients undergoing cardiac surgery from Feb 2014 – Apr 2020 at a Western Australian hospital was performed. Patients were categorised depending on the timing of their requirement for IABP. Primary outcomes included 30-day mortality; secondary outcomes included postoperative complications (gastrointestinal, pneumonia and multi-system organ failure). A propensity score was created for the usage of IABP and an adjusted analysis was performed. IABP was used in higher-risk patients indexed by the propensity score. Of 2417 patients, 148 (6.1%) patients required IABP. Of those 103 had preoperative IABP, 40 had intraoperative IABP and five had postoperative IABP insertion. After propensity score adjustment, mortality was significantly higher in the IABP group (OR 5.76, 95% CI 2.91 -11.35). Gastrointestinal complications (OR 3.69, 95% CI 1.59-8.57), pneumonia (OR 2.29, 95% CI 1.24-4.16) and multisystem organ failure (OR 3.64, 95% CI 1.37-9.67) were higher in the IABP group. A subgroup analysis of preoperative IABP use showed mortality to be significantly higher (OR 2.884, 95% CI 1.09-7.67). Gastrointestinal complications (OR 5.06, CI 2.01-12.77) and pneumonia (OR 2.476, CI 1.26-4.88) were also significantly higher in the preoperative IABP group. Perioperative IABP is associated with increased mortality and major postoperative complications. These results may be due to residual confounding. The increased mortality in the adjusted preoperative IABP group warrants further investigation.