Cardiovascular Surgery, Vol. 11,No.2, pp.145–148, 2003  2003 The International Society for Cardiovascular Surgery Published by Elsevier Science Ltd. All rights reserved. 0967-2109/03 $30.00 www.elsevier.com/locate/cardiosur doi:10.1016/S0967-2109(03)00009-7 Pre-operative balloon counterpulsation and off- pump coronary surgery for high-risk patients G. Babatasi ∗ , M. Massetti ∗ , P. G. Bruno ∗ , M. Hamon ∗ , O. Le Page ∗ , R. Morello † and A.Khayat ∗ ∗ Cardiovascular and Thoracic Surgery, University Hospital, Avenue Co ˆ te de Nacre, CHU Caen 14033 Caen, France and †Department of Biostatistics, University Hospital, Avenue Co ˆ te de Nacre, CHU Caen 14033 Caen, France Coronary artery bypass surgery (CABG) can be performed less invasively without cardio- pulmonary bypass (CPB). Multivessel off-pump CABG (OPCAB) is challenging in patients with criticaleft main stenosis (⬎ 70%) and/or severe ventricular dysfunction (ejection fraction ⬍ 0.35) Our objective was the evaluation of efficiency of intra aortic balloon pump (IABP) preoper- atively in this high-risk group in order to perform OPCABG safely. Materialand method: In a consecutive 10-month period (out of 88 OPCABG patients) 23 high-risk patients were treated and were compared with 15 on-pump patients (out of 69) with the same criteria. Results:Preoperative implantation of IABP was significantly higher in the OPCABG group (70% vs 46%,p ⬍ 0.05). No conversion to CPB was required in the OPCABG group. Post- operative angiography was systematically performed and demonstrated 97.5% patency of anastomosis. No device-related complications occured. No difference was found concerning age,risk factors,emergency surgery, ejection fraction, mean number of grafts per patient (2.64 versus 2.75) and average operating time. In contrast,OPCABG demonstrated a trend toward reduced morbidity in terms of atrial fibrillation,reexploration for bleeding and pro- longed ventilator requirement ⬎ 12 h. Mortality was less in the OPCABG group (p ⬍ 0.05). Conclusion: More randomized controlled trials are needed to evaluate the true efficacy of elective IABP in OPCABG high-risk patients. Untilsuch studies are evaluated, and therefore because older and sicker patients now constitute a greater percentage of candidates for OPCABG, the timing of application of the IABP is warranted. These results may further justify preoperative use of the IABP in a large proportion of this group of patients.  2003 The International Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rights reserved. Keywords: coronary surgery, off-pump coronary artery bypass, intra-aortic balloon pump, high- risk population Introduction Many of the adverse outcomes have been reported for elderly patients undergoingcoronary artery Corresponding author. Tel.: +33 2 31065166; fax: +33 2 31065165; e-mail: babatasi-g@chu-caen.fr; gebab1@libertysurf.fr CARDIOVASCULAR SURGERY April2003 VOL 11 NO 2 145 bypass grafting (CABG) in whom intra-aortic bal- loon counterpulsation (IABP)was set emergently during either intra-operative or post-operative hemo- dynamic decompensation [1]. Christenson et al [2] have demonstrated that these complications can be minimized by preoperative placement of the IABP. The use of off-pump coronary artery bypass grafting (OPCABG) increased as many reports [3, 4] showed