Intra-aortic balloon counterpulsation (IABP) is an assisted circulatory method to improve cardiac function by synchronizing the inflation and deflation of the balloon with the heart to reduce cardiac afterload, decrease systolic ventricular wall tension, reduce myocardial oxygen consumption, increase coronary blood supply, and improve myocardial perfusion. In clinical practice, we found that the application of IABP in elderly patients has its own special characteristics, and the early and reasonable use of IABP has positive significance in reducing perioperative mortality. IABP is a temporary mechanical circulatory aid widely used in clinical practice, and the therapeutic effect depends on the indications and the timing of application. In clinical practice, the indications for IABP are: 1) ischemic heart disease, cardiogenic shock and severe complications (acute mitral valve insufficiency, septal perforation, etc.); 2) high-risk perioperative cardiac patients who have difficulty disengaging from extracorporeal circulation or are expected to have severe postoperative cardiac hypoperfusion; 3) persistent perioperative hypovolemia in which pharmacological treatment is not effective; 4) end-stage heart disease awaiting placement of an artificial heart short-term cardiac function support for patients with assisted devices or heart transplantation; 5. Hemodynamic indices: ① arterial systolic pressure <12.0kPa (90mmHg) and diastolic pressure <8.0kPa (60mmHg); ② pulmonary gross wedge pressure >2.1-2.4kPa (16-18mmHg); ③ cardiac index <2.0Lmin-1m-2. For elderly patients, the IABP remains an active treatment, and because of its relatively poor ability to withstand surgical strikes, it is better to anticipate and use it early than to wait until the emergency application of IABP after the hemodynamic index is unstable. In this study, the effect of intraoperative and postoperative placement of IABP in patients with coronary artery disease group was significantly higher than that of preoperative placement in terms of morbidity and mortality rate, which was statistically different, while there was no significant difference between preoperative, intraoperative and postoperative groups before IABP placement (P>0.05), which was consistent with the trend reported in China. In addition, the complication rate in the preoperative IABP placement group was significantly less than that in the intraoperative and postoperative placement groups (P<0.05). In clinical practice, our experience is that the application of IABP should be actively considered in the following cases: 1, those with persistent angina pectoris with worsening cardiac function; 2, those who decide to perform emergency surgery; 3, those who have already applied moderate doses of positive inotropic drugs before surgery; 4, those who are expected to tolerate poor intraoperative cardiac maneuvering during OPCAB surgery; 5, those with serious preoperative complications, such as septal perforation; 6, those with Those with uncontrollable causes of arrhythmias related to cardiac function. In terms of the type of disease used, early applications are more mixed, and IABP is considered for cases with both LOS and intractable arrhythmias. Our experience is that the efficacy of IABP is positive for coronary artery disease and questionable for other diseases. In our group, the applied mortality rate was 70.00% in the non-coronary group compared to 23.47% in the coronary group. For the sudden onset of hypotension in the late perioperative period of CABG, the cause should also be clearly identified for timely resuscitation, and IABP does not completely assist in removing it from danger. During the use of IABP, monitoring of ACT is crucial. If increased postoperative drainage is found, we do not recommend achieving hemostasis by reducing ACT time, and increasing plasma input and necessary open-heart hemostasis are the fundamental methods to solve the problem. The sequence of IABP withdrawal is: 1) remove the tracheal intubation, and for those who cannot be detached from the ventilator, tracheotomy should be considered first; 2) reduce the use of positive inotropic drugs, such as dobutamine to 5 μg kg-1min-1 and epinephrine to 0.1 μg kg-1min-1; 3) after the hemodynamic status is stable, reduce the counterpulsation ratio from 1:1 to 1:2, 1:3 or 1:4 every 2-4 h, respectively. When there is no change in the condition, the pacing is stopped for 30-45 min, and the balloon counterpulsation catheter can be removed if the indicators are good and the coagulation mechanism is adjusted. When removed, some blood should be allowed to rush out of the wound to bring out small thrombi, and then the femoral artery puncture site should be pressed for 30 min and pressure bandaged for 8 h. The main concern about the application of IABP in clinical practice is the high complications. Kantrowitz et al. reported an incidence of up to 45%, but only 4% actually occur and leave functional impairment or cause death, compared with 2.54% in this study, but this is higher than the overall average in our institution. Elderly patients, especially those with coronary artery disease, have a higher degree of systemic atherosclerosis than normal people, and the risk of applying IABP is also higher than normal people. For patients with severe coronary artery disease, femoral artery puncture tubes should be routinely left in place during anesthesia; 4. Monitor the dorsalis pedis artery and lower extremity blood flow; 5. Remove IABP as early as possible when normal hemodynamics can be maintained with conventional doses of positive inotropic drugs. The adjuvant effect of IABP on the heart is also limited, and patients with very severe disease should master the indications for its use. In such patients, left-sided or whole-heart assist should be considered, and heart transplantation should be considered if necessary. We have tried left-heart assist and whole-heart assist in critically ill patients, and our experience needs to be further summarized. In conclusion, perioperative application of IABP for cardiac surgery in elderly patients is a safe and effective circulatory assistance modality, which can be actively applied to high-risk coronary heart disease patients in the perioperative period to reduce the morbidity and mortality rate.