Con: Prophylactic Preoperative Use of an Intra-aortic Balloon Pump Is Not Indicated in High-Risk Coronary Patients Undergoing Coronary Artery Bypass Grafting.

THE PRIMARY EFFECT of the intra-aortic balloon pump (IABP) is to optimize the precarious balance between myocardial oxygen supply and demand, a vital component of the management of patients with coronary artery disease. Myocardial oxygen supply is improved through an enhancement of diastolic coronary blood flow and subendocardial perfusion, while a reduction in left ventricular afterload reduces oxygen demand. Whereas use of the IABP as a therapeutic intervention in patients with ongoing acute coronary syndromes and cardiogenic shock is of physiologic benefit, the prophylactic preoperative application of the IABP for high-risk hemodynamically stable patients undergoing coronary artery bypass surgery lacks a consensus. The authors hereby discuss, backed with evidence, the “con” side of prophylactic preoperative insertion of the IABP in hemodynamically stable high-risk patients undergoing coronary artery bypass grafting (CABG).