title: Preoperative intra-aortic balloon pump use in high-risk patients prior to coronary artery bypass graft surgery decreases the risk for morbidity and mortality-A meta-analysis of 9,212 patients.
abstract: OBJECTIVE
  Prophylactic 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  Current evidence from RCT and OT suggests beneficial effects for the IABP in high-risk patients before CABG surgery.
authors.affiliation: Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
authors.forename: Antje-Christin
authors.initials: AC
authors.lastname: Deppe
authors.affiliation: Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Weber
authors.affiliation: Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Liakopoulos
authors.affiliation: Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Zeriouh
authors.affiliation: Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Slottosch
authors.affiliation: Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Scherner
authors.affiliation: Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
authors.forename: Elmar W
authors.initials: EW
authors.lastname: Kuhn
authors.affiliation: Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.|Center of Molecular Medicine Cologne, University of Cologne, Cologne, Germany.
authors.forename: Yeong-Hoon
authors.initials: YH
authors.lastname: Choi
authors.affiliation: Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wahlers
mesh_terms: D002303:Cardiac Output, Low / Q000517:prevention & control; D001026:Coronary Artery Bypass / Q000401:mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007902:Length of Stay / Q000706:statistics & numerical data; D009017:Morbidity; D009203:Myocardial Infarction / Q000517:prevention & control*; D064887:Observational Studies as Topic; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care; D016032:Randomized Controlled Trials as Topic; D051437:Renal Insufficiency / Q000517:prevention & control; D012306:Risk
keywords: cardiac surgery; high risk patients; intra-aortal balloon pump