Efficacy and safety of preoperative intra-aortic balloon pump use in patients undergoing cardiac surgery: a systematic review and meta-analysis

Abstract Background Intra-aortic balloon pump (IABP) can be used prior to coronary artery bypass graft surgery (CABG) in high-risk patients. Whether this technique remains safe and effective in contemporary practice is controversial. Objective We have completed a systematic review and meta-analysis...

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Bibliographic Details
Published in:	International journal of cardiology 2016-03, Vol.207, p.67-79
Main Authors:	Poirier, Yann, Voisine, Pierre, Plourde, Guillaume, Rimac, Goran, Barria Perez, Alberto, Costerousse, Olivier, Bertrand, Olivier F
Format:	Article
Language:	eng
Subjects:	Cardiac surgery Cardiac Surgical Procedures - adverse effects Cardiac Surgical Procedures - methods Cardiovascular Humans IABP Intra-Aortic Balloon Pumping - adverse effects Intra-Aortic Balloon Pumping - methods Length of Stay - trends Meta-analysis Observational Studies as Topic - methods Postoperative Complications - diagnosis Postoperative Complications - prevention & control Preoperative Care - adverse effects Preoperative Care - methods Preoperative IABP Randomized Controlled Trials as Topic - methods Risk Factors Treatment Outcome
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Summary:	Abstract Background Intra-aortic balloon pump (IABP) can be used prior to coronary artery bypass graft surgery (CABG) in high-risk patients. Whether this technique remains safe and effective in contemporary practice is controversial. Objective We have completed a systematic review and meta-analysis of randomized trials and observational studies to evaluate the safety and benefits of IABP prior to CABG surgery. Methods We searched PubMed, EMBASE, Cochrane Library databases, with cross-referencing of relevant articles for studies assessing the impact of IABP prior to and after isolated CABG. Two investigators independently sorted the potentially relevant studies, and three extracted data. The assessed outcomes included in-hospital and 30-day mortality, IABP-related complications and length of intensive care unit and hospital stay. Results From 1977 to 2015 we included 11 randomized controlled trials (n = 1293) (RCTs) and 22 observational studies, including a total of 46,067 patients. Analyses from RCTs suggested that IABP prior to CABG was associated with a significant reduction in hospital mortality (odds ratio (OR) 0.20; 95% confidence interval (CI): 0.09–0.44; P < 0.0001) and 30-day mortality compared to no preoperative IABP (OR 0.43, 95% CI: 0.25–0.76; P = 0.003). IABP prior to CABG was also associated with shorter intensive care unit (weighted mean difference (WMD) − 1.47 day; 95% CI: − 1.82 to − 1.12 day; P < 0.00001) and hospital length of stay (WMD − 3.25 days; 95% CI: − 5.18 to − 1.33 days; P = 0.0009). However, there were significant bias and limitations among included studies. Furthermore, results for similar outcomes from observational studies remained inconclusive. Conclusions In contemporary practice, evidence showing clinical benefit for preoperative IABP in high-risk patients remains limited and requires further validation in an appropriately sized multicenter randomized trial.
ISSN:	0167-5273 1874-1754