Contemporary Single-Center Experience with Axillary Intra-Aortic Balloon Pumps

Abstract

<h3>Purpose</h3> Intra-aortic balloon pumps (IABP) are increasingly being utilized to augment hemodynamic support in patients awaiting heart transplantation. In this subset of patients, the use of axillary IABP has the benefits of allowing increased mobility and decreased risk of infection when compared to the femoral approach for IABP. To further gain insight into the risks and benefits of this approach, we performed a retrospective review of our center's experience with axillary IABP. <h3>Methods</h3> We conducted a retrospective review of adult patients undergoing axillary IABP placement from July 2017 to April 2021. Variables collected included general patients' characteristics such as gender, age and comorbidities, indication for axillary IABP placement, hemodynamic parameters before and after IABP, days on axillary IABP, days from initial axillary IABP to transplant, postoperative and device complications. <h3>Results</h3> A total of 42 adults underwent open axillary IABP placement during the study period. Mean age was 52 years and most of the patients were male. The most common etiology was non-ischemic with an indication of bridge to transplantation (BTT) (<b>Table</b>). Successful orthotopic heart transplantation was performed in 40 of these patients. Mean duration of axillary IABP support was 19 days and mean duration from initial axillary IABP insertion to transplant was 27 days. Cardiac output and cardiac index significantly increased after IABP placement (p<0.001). Ten patients required one balloon exchange and two required two exchanges. Device malfunction was the most common IABP complication and acute kidney injury was the most common patient complication. There were no mortalities related to IABP placement. <h3>Conclusion</h3> Axillary intra-aortic balloon pump use has risen over the past years. The most common indication for axillary IABP at our institution was BTT with a success rate of 97.5%. The most common balloon complication was malfunction requiring an exchange, and the most common patient complication was acute kidney injury.