Percutaneous placement of an intra-aortic balloon pump in the left axillary/subclavian position provides safe, ambulatory long-term support as bridge to heart transplantation

Jerry D. Estep, Andrea M. Cordero-Reyes, Arvind Bhimaraj, Barry Trachtenberg, Nashwa Khalil, Matthias Loebe, Brian Bruckner, Carlos M. Orrego, Jean Bismuth, Neal S. Kleiman, Guillermo Torre-Amione

Research output: Contribution to journalArticle

68 Scopus citations

Abstract

Objectives: This study evaluated the feasibility, tolerability, and efficacy of a strategy for percutaneous intra-aortic balloon pump (IABP) placement through the left axillary-subclavian artery to provide mechanical circulatory support in patients with end-stage heart failure as a bridge to heart transplantation. Background: The transfemoral approach to IABP placement is associated with major disadvantages, including the risk for infection and limitation of patient mobility in those requiring extended support. Methods: We developed a percutaneous technique for placing IABPs in the left axillary artery that permits upright sitting and ambulation. We performed a retrospective review of data from patients who had undergone left axillary IABP implantation between 2007 and2012. Results: Fifty patients who received a left axillary IABP as a bridge to transplantation were identified, of whom 42 (84%) underwent heart or heart-multiorgan transplantation. Cumulative survival on IABP support was 92%, and post-transplant 90-day survival was 90%. Median duration of support was 18 days. Four of 50 patients (8%) died while on IABP support, and 3 (6%) received greater mechanical circulatory support. Four patients (8%) had clinically significant thromboembolic or bleeding events without long-term sequelae. The most common minor adverse event was IABP malposition, in 22 patients (44%). Prolonged IABP support in the heart-transplantation cohort was associated with significant improvements in mean pulmonary artery pressure and in creatinine and total bilirubin concentrations. Conclusions: Percutaneous insertion of an IABP through the left axillary artery is a feasible and relatively well-tolerated strategy tobridge patients with end-stage heart failure to heart transplantation. This form of mechanical-device treatment permits upright sitting and ambulation in those requiring extended support.

Original languageEnglish (US)
Pages (from-to)382-388
Number of pages7
JournalJACC: Heart Failure
Volume1
Issue number5
DOIs
StatePublished - Oct 1 2013
Externally publishedYes

Keywords

  • CXR
  • HF
  • Heart failure
  • Heart transplant
  • IABP
  • Intra-aortic balloon pump
  • LVAD
  • OHT
  • Subclavian artery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Estep, J. D., Cordero-Reyes, A. M., Bhimaraj, A., Trachtenberg, B., Khalil, N., Loebe, M., Bruckner, B., Orrego, C. M., Bismuth, J., Kleiman, N. S., & Torre-Amione, G. (2013). Percutaneous placement of an intra-aortic balloon pump in the left axillary/subclavian position provides safe, ambulatory long-term support as bridge to heart transplantation. JACC: Heart Failure, 1(5), 382-388. https://doi.org/10.1016/j.jchf.2013.06.002