Outcomes of ambulatory axillary intra-aortic balloon pump as a bridge to heart transplantation

Hidefumi Nishida, Yojiro Koda, Sara Kalantari, Ann Nguyen, Bow Chung, Jonathan Grinstein, Gene Kim, Nitasha Sarswat, Bryan Smith, Tae Song, David Onsager, Valluvan Jeevanandam, Takeyoshi Ota
Annals of Thoracic Surgery 2020 August 31

BACKGROUND: The axillary intra-aortic balloon pump (IABP) is utilized frequently in selected patients for circulatory support as a bridge to heart transplantation. The purpose of this study is to investigate the safety and efficacy of axillary intra-aortic balloon pump support for heart transplant candidates.

METHODS: We collected data regarding 133 patients who underwent axillary IABP support as a bridge to transplantation from July 2009 to April 2019. Of these patients, 94(70.7%) underwent IABP insertions with surgical axillary grafts, and 39(29.3%) underwent percutaneous IABP insertions. The outcomes of interest included ambulatory data, IABP-related complications, and successful transplantation with this type of support.

RESULTS: Overall preoperative ejection fraction was 20.3 ± 8.0%. The median duration of axillary IABP support was 21days with 131patients (98.5%) mobilizing with the device. Hemodynamic parameters significantly improved after the axillary IABP support was placed. Overall, 122 patients(91.7%) were successfully bridged to transplantation. Six patients(4.5%) required escalation to further mechanical support(s). Two patients(1.5%) died while awaiting transplantation. Four patients(3.0%) experienced a stroke during axillary IABP support (before transplantation:3, after transplantation:1). Two of the 3 patients with a stroke diagnosis before transplantation recovered and eventually received transplantation.

CONCLUSIONS: With axillary IABP support, most patients were able to ambulate and undergo physical rehabilitation while waiting for transplantation. This study demonstrates that axillary IABP results in a high success rate of bridge to transplant and a low number of complications. Thus, ambulatory axillary IABP provided efficient and safe support for the selected bridge to transplant patients.

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