Commentary: Percutaneous supraclavicular subclavian intra-aortic balloon pump insertion—A straighter route to fewer complications?

Abstract

Intra-aortic balloon pumps (IABPs) are circulatory support devices that may potentially improve coronary and systemic perfusion in patients with cardiogenic shock. The goal is to provide sufficient stabilization to allow for myocardial recovery or successful bridge to durable therapy, such as left ventricular assist device implantation or heart transplantation. 1 Despite its ancient form of mechanical support, there is enthusiasm toward IABP use, especially after the heart allocation policy change in 2018. 2 Conventionally, the femoral artery is used for IABP insertion, given ease of access. However, due to location, an important disadvantage is the inability of the patient to ambulate. This increases the risk of debilitation and may become a critical issue for recovery from destination therapy. [3][4][5][6] Given this limitation, alternative approaches have been explored. Current techniques include surgical and percutaneous IABP placement via the axillary or subclavian artery. These approaches provide patients with mechanical hemodynamic support while also enabling patients to mobilize and participate in physical therapy. [3][4][5][6] The first IABP placement involving the axillary artery was performed in 1989 using a modified surgical