Background:

Use of intra-aortic balloon pump (IABP) during coronary artery bypass grafting (CABG) identifies a high-risk subgroup with substantial perioperative mortality. Determinants of outcome in this setting remain incompletely defined, particularly regarding hemodynamic severity and intraoperative timing of IABP insertion relative to cardiopulmonary bypass (CPB). We aimed to identify independent predictors of in-hospital mortality among CABG patients requiring IABP support and to evaluate whether the intraoperative interval between CPB separation and IABP insertion influences outcome.

Methods:

A retrospective analysis of CABG patients supported with IABP was performed. 113 Patients who underwent on-pump CABG with IABP between March 2020 and March 2025 were included. Baseline characteristics, operative variables—including CPB time and precise intraoperative IABP timing—and postoperative outcomes were recorded. Multivariate logistic regression was used to identify independent predictors of mortality.

Results:

In-hospital mortality was high and consistent with previously reported surgical IABP cohorts. Lower preoperative ejection fraction, prolonged CPB duration, and higher inotrope requirement independently predicted mortality, indicating that outcome was primarily driven by myocardial dysfunction, bypass-related stress, and persistent hemodynamic instability. Sex was associated with mortality but was not a primary determinant of risk. The interval between CPB weaning and IABP initiation did not show statistical significance; however, interpretation was limited by substantial missing data and restricted variability in recorded timings.

Conclusion:

Among CABG patients requiring IABP, early mortality is determined mainly by the severity of ventricular dysfunction, operative complexity, and residual circulatory failure rather than by IABP use itself. Although the intraoperative timing of IABP relative to CPB separation was not statistically significant in this study, methodological limitations prevent ruling out a clinically significant effect. Prospective studies with precise, complete intraoperative timing data are needed to define optimal timing and refine risk stratification.