Cor Vasa 2026, 68(5):546-554 | DOI: 10.33678/cor.2026.065

Impact of Preoperative Versus Intraoperative and Postoperative Intra-Aortic Balloon Pump Insertion on Mortality and Clinical Outcomes in High-Risk Coronary Artery Bypass Grafting Patients: A Systematic Review and Meta-Analysis

Muhammad Caesar Borni Agustio Putra Hutabarat^{a, b}, Danang Himawan Limanto^{a, b}, Mohamad Rizki^a, Yan Efrata Sembiring^{a, b}

^a Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia

^b Department of Thoracic, Cardiac and Vascular Surgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

Introduction: The optimal timing of intra-aortic balloon pump (IABP) insertion in high-risk coronary artery bypass grafting (CABG) remains controversial. While preoperative IABP may provide early hemodynamic stabilization, intraoperative or postoperative insertion is typically performed as rescue therapy after hemodynamic deterioration. This study aimed to evaluate the impact of preoperative versus intraoperative/ postoperative IABP insertion on mortality and clinical outcomes in high-risk CABG patients.

Methods: A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. PubMed and ScienceDirect were searched for studies published between January 2000 and January 2025. Eligible studies included adult high-risk CABG patients directly comparing preoperative and delayed (intra operative/postoperative) IABP insertion. The primary endpoint was short-term mortality (in-hospital or 30-day). Secondary outcomes included major adverse cardiac events (MACE), prolonged mechanical ventilation, ICU stay, hospital stay, and duration of IABP support. Random-effects meta-analysis was performed using RevMan 5.4.

Results: Ten studies comprising 49,557 patients were included. Preoperative IABP insertion was associated with significantly reduced in-hospital mortality (OR 0.52; 95% CI 0.33-0.81; p = 0.004) and 30-day mortality (OR 0.12; 95% CI 0.05-0.31; p <0.001). Major adverse cardiac events were also significantly lower (OR 0.54; 95% CI 0.39-0.76; p <0.001). Prolonged mechanical ventilation was reduced (OR 0.38; 95% CI 0.15-0.96; p = 0.04). No significant differences were observed in ICU stay, hospital stay, ventilation duration, or IABP support duration.

Conclusion: Preoperative IABP insertion is associated with improved short-term survival and reduced perioperative complications in high-risk CABG patients, supporting a proactive rather than rescue strategy in carefully selected individuals.

Keywords: Coronary artery bypass grafting, Hemodynamic support, Intra-aortic balloon pump, Meta-analysis, Mortality

Received: February 21, 2026; Revised: February 21, 2026; Accepted: July 17, 2026; Prepublished online: October 12, 2026; Published: October 20, 2026  Show citation