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There are few studies of the use of intra-aortic balloon pump (IABP) treatment as a bridge to heart transplantation (HTx). This is the first study to compare long-term clinical and haemodynamic outcomes in IABP-treated HTx patients and electively transplanted patients.This was a retrospective study of all adult HTx recipients between 2001 and 2007. Thirty-two patients (aged 50 ± 13 years) treated with IABP, as a bridge to HTx due to severe hypo-perfusion, were compared with 135 electively transplanted patients (aged 54 ± 11 years). The mean time from onset of IABP to HTx was 21 ± 16 days. Clinical condition improved during IABP treatment. Serum creatinine decreased from 128 ± 56 to 102 ± 29 µmol/L (P < 0.01), aspartate transaminase from 682 ± 1299 to 63 ± 89 U/L (P=0.01), and ALAT from 483 ± 867 to 126 ± 284 U/L (P=0.02). Intra-aortic balloon pump treatment related complications were few. Mortality was similar in the IABP and control groups at 30 days post-HTx (6.2 vs.3.7%, P=0.54), at 1 year (9.4 vs.11.1%, P=0.80), and beyond. Long-term clinical and haemodynamic indices were similar in the two groups.Intra-aortic balloon pump treatment stabilizes patients in end-stage heart failure, is safe, well tolerated, and is successful in bridging acutely decompensated patients to transplantation. Complications are few and manageable. Following IABP and HTx, short- and long-term survival, biochemical and invasive and non-invasive haemodynamic outcomes were similar to those in electively transplanted patients.