Use of Intra-aortic balloon pump in Ischemic Heart Disease Patients with Impaired Left Ventricle: 7 Years’ Experience in MTI-HMC, Peshawar, Pakistan

Objectives: This study evaluates the outcomes of intra-aortic balloon pump (IABP) use in high-risk patients with impaired left ventricular (LV) function (EF ≤45%) undergoing coronary artery bypass grafting (CABG).

Methodology: A retrospective analysis of 1683 CABG patients identified 481 with significant LV dysfunction, of whom 55 (11.4%) required IABP support at Hayatabad Medical Complex (2018–2025). Data from these 55 patients were analyzed for outcomes and predictors.

Results: Mean age was 59.4 ± 10.5 years, mean EF 33.9 ± 3.7%. Most were male (81.8%), with comorbidities including hypertension (45.5%) and diabetes (29.1%). Mean CPB time was 166.1 ± 30.0 minutes; 98.2% received LIMA-LAD grafting. Most (90.9%) underwent elective CABG, while 5.5% required emergent CABG (e.g., ventricular septal rupture). Postoperative outcomes included in-hospital mortality (38.2%), re-intubation (29.1%), and arrhythmias (23.6%).

Conclusion: IABP is an effective first-line mechanical support in high-risk CABG patients with LV dysfunction, with better outcomes when inserted early intraoperatively. However, its use remains associated with increased mortality. Further prospective studies are needed to optimize its role.