Mechanical circulatory assistance is frequently needed to support the failing heart. The aim of this study was to determine perioperative prognostic factors for hospital mortality in patients undergoing open heart surgery who required intraaortic balloon pump support. Between January 2002 and September 2006, 475 patients received an intraaortic balloon pump perioperatively. Hospital mortality was 21.89%. Risk factors for hospital death identified by multivariate logistic regression analysis were peripheral vascular disease, left main coronary artery disease, postoperative renal failure, postoperative cardiac arrest, and prolonged hospital stay. Minor and major intraaortic balloon pump-related complications were not significant in univariate and multivariate analysis; the incidence was 5.05%. It is suggested that the threshold for using balloon pump support is decreased in high-risk patients undergoing cardiac surgery.