Factors associated with intra-aortic balloon pump use in patients with left ventricular dysfunction after cardiac surgery at Hanoi Heart Hospital

Low cardiac output syndrome in patients with reduced left ventricular systolic function undergoing cardiac surgery with cardiopulmonary bypass often requires hemodynamic support, and the intra-aortic balloon pump (IABP) is one of the commonly used mechanical circulatory support devices. Early identification of factors associated with IABP use may facilitate risk assessment and preparation of an appropriate circulatory support strategy for these patients. Objective: To identify factors associated with the indication for intra-aortic balloon pump (IABP) use in patients with reduced left ventricular function undergoing cardiac surgery with cardiopulmonary bypass. Patients and Methods: This retrospective case–control study included 663 adult patients with a left ventricular ejection fraction (LVEF) <40% who underwent cardiac surgery with cardiopulmonary bypass at Hanoi Heart Hospital from May 2018 to March 2025. Of these, 188 patients received IABP support and 475 patients did not. Multivariable logistic regression analysis was performed to identify factors independently associated with IABP use. Results: Patients in the IABP group had higher proportions of NYHA class III–IV. They also had a lower mean LVEF, a larger left ventricular end-diastolic diameter (LVEDD), and higher blood lactate levels than patients in the non-IABP group. Multivariable analysis identified five factors independently associated with IABP use: LVEF <30% (OR = 2.6; 95% CI: 1.6–4.2; p < 0.001), LVEDD >60 mm (OR = 1.9; 95% CI: 1.3–2.9; p = 0.002), lactate >2 mmol/L (OR = 2.8; 95% CI: 1.8–4.5; p < 0.001), emergency surgery (OR = 1.8; 95% CI: 1.1–3.0; p = 0.028), and combined valvular and coronary artery surgery (OR = 1.6; 95% CI: 1.05–2.6; p = 0.036). Intensive care unit stay and total hospital stay were longer in the IABP group, whereas in-hospital mortality did not differ significantly between the two groups (4.3% vs. 4.2%; p = 0.979). Conclusion: In patients with LVEF <40% undergoing cardiac surgery with cardiopulmonary bypass, LVEF <30%, LVEDD >60 mm, lactate >2 mmol/L, emergency surgery, and combined valvular and coronary artery surgery were independently associated with IABP use.