Prophylactic IABP in patients with severe ventricular dysfunction undergoing CABG: impact on early postoperative outcomes

BACKGROUND: The mechanical hemodynamic support provided by IABP placement is recognized in cases of cardiogenic shock or severe clinical compromise. The benefits of its prophylactic use before CABG in patients with severe ventricular dysfunction but in the absence of critical conditions remain controversial. METHOD: We conducted a retrospective analysis by NACSA ​​of 16,222 patients with LVEF < 30% indicated for CABG in the absence of clinical emergencies between 1996 and 2018. 634 underwent prophylactic preoperative IABP and were matched 1:1 using PSM with patients not receiving IABP. Of these, 634 patients received preoperative prophylactic IABP. PSM (1:1) was performed, followed by doubly robust logistic regression analysis. The primary outcome was 30-day mortality. Secondary outcomes included postoperative CVA, postoperative dialysis, re-exploration for bleeding, and DSWI. Finally, a sensitivity analysis was conducted stratifying the population based on the surgical technique used: off-pump or on-pump. RESULTS: After matching, 557 pairs of patients were analyzed. No significant differences were observed between groups in 30-day mortality (7.0% vs. 4.1%; OR 1.65, 95% CI 0.98-2.71; p = 0.058) or in secondary outcomes, including CVA (OR 0.74, 95% CI 0.23-2.12; p = 0.62), dialysis (OR 1.39, 95% CI 0.84-2.38; p = 0.16), re-exploration for bleeding (OR 1.15, 95% CI 0.85-2.01; p = 0.43), and DSWI (OR 1.39, 95% CI 0.41-4.38; p = 0.49). These findings were consistent in doubly robust analyses. Sensitivity analyses stratified by surgical technique showed no significant associations, although estimates in the off-pump subgroup were imprecise. CONCLUSIONS: Prophylactic preoperative IABP use was not associated with a significant reduction in early mortality or major postoperative complications after adjustment for baseline risk.