• Antje-Christin Deppe, Carolyn Weber, Oliver J Liakopoulos, Mohamed Zeriouh, Ingo Slottosch, Maximilian Scherner, Elmar W Kuhn, Yeong-Hoon Choi, and Thorsten Wahlers.
• Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
• J Card Surg. 2017 Mar 1; 32 (3): 177-185.

AimsProphylactic intra-aortic balloon pump (IABP) support for high-risk patients before coronary artery bypass grafting (CABG) is controversial. This meta-analysis sought to determine the current role of preoperative IABP support.MethodsWe performed a meta-analysis of randomized (RCT) and observational trials (OT) that fulfilled the following criteria: (1) Group comparison of patients with prophylactic IABP implantation before CABG with a control group; (2) reporting at least one desired clinical endpoint, including all-cause mortality, myocardial infarction, cerebrovascular accident (CVA), and renal failure. Pooled treatment effects (odds ratio [OR] or weighted mean difference, and 95% confidence intervals [95%CI]) were assessed using a fixed or random effects model.ResultsA total of 9,212 patients from 23 studies (7 RCT, 16 OT) were identified after a literature search of major databases using a predefined keyword list. Absolute risk reduction for mortality in RCTs was 4.4% (OR 0.43; 95%CI 0.25-0.73; p = 0.0025). Prophylactic IABP use before CABG surgery also decreased the risk for myocardial infarction (OR 0.58; 95%CI 0.43-0.78; p = 0.004), CVA (OR 0.67; 95%CI 0.47-0.97; p = 0.042), and renal failure (OR 0.62; 95%CI 0.47-0.83; p = 0.0014). Length of intensive care unit stay (p < 0.0001) and length of hospital stay (p < 0.0001) were significantly reduced in patients with preoperative IABP use.ConclusionCurrent evidence from RCT and OT suggests beneficial effects for the IABP in high-risk patients before CABG surgery.© 2017 Wiley Periodicals, Inc.

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