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

Abstract

Percutaneous insertion of an IABP through the left axillary artery is a feasible and relatively well-tolerated strategy to bridge 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.

Mobilizing pre-heart-transplant patients with a percutaneously placed axillary-subclavian intraaortic balloon pump: A retrospective study

“…Bleeding at the insertion site was observed in 4% (n = 2) of the patients and was treated by stopping and or decreasing the heparin infusion dose (see Table 2). No data were gathered on malposition/exchange of the PAxIABP catheter owing to incomplete charting, although increased incidence of IABP catheter malposition was reported by Estep, 2013. [15] Notable problems encountered during ambulation were 1 episode of IABP console shutdown (the console was plugged in at the nearest wall outlet) and 1 episode of ventricular tachycardia without loss of conciousness that resolved spontaneously.…”

“…This procedure is done with a direct axillary artery percutaneous stick using a J wire guide inserted into the left brachial artery or femoral artery into the axillarysubclavian artery as a roadmap. [15] A regular intraaortic balloon pump catheter and console is used. The sheath and IABP catheter are sutured in place, secured with stat lock at the hub, and dressed with Tegaderm CHG (3M).…”

Prolonged duration of transbrachial intra-aortic balloon pump as bridge to heart transplantation

“…Percutaneous placement of IABP in axillary/subclavian position has been described as a bridge to heart transplantation 4. However, this technique requires major vascular intervention.…”

“…The axillary and transaortic routes have been cited as alternatives in case reports, but these frequently require surgical intervention 2 3. A case of percutaneously placed axillary IABP has been described 4. We describe a case of a percutaneously placed IABP via the brachial approach.…”

Why All the Pushback against Counterpulsation?

“…The mean SBP was 103 mm Hg, with an average cardiac index of 2.1 L/min/m 2 . Median time of support was 18 days (range 4-152), with evidence of improvement in certain markers of end-organ function and hemodynamics [12]. In a single center retrospective study including 54 ADHF patients, Sintek et al [13] demonstrated that IABP prior to implantation of a left ventricular assist device led to clinical stability, without significant difference in mortality between those stabilized from those who decompensated.…”