Jerry D Estep1, Andrea M Cordero-Reyes2, Arvind Bhimaraj2, Barry Trachtenberg2, Nashwa Khalil2, Matthias Loebe3, Brian Bruckner3, Carlos M Orrego2, Jean Bismuth3, Neal S Kleiman2, Guillermo Torre-Amione4. 1. The Methodist DeBakey Heart & Vascular Center, Department of Cardiology, Houston, Texas. Electronic address: jestep@houstonmethodist.org. 2. The Methodist DeBakey Heart & Vascular Center, Department of Cardiology, Houston, Texas. 3. The Methodist DeBakey Heart & Vascular Center, Department of Surgery, Houston, Texas. 4. The Methodist DeBakey Heart & Vascular Center, Department of Cardiology, Houston, Texas; Catedra de Cardiologia y Medicina Vascular, Escuela de Medicina, Tecnologico de Monterrey, Monterrey, Mexico.
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 and 2012. 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 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.
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 and 2012. 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 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.
Authors: Brandi A Bottiger; Alina Nicoara; Laurie D Snyder; Paul E Wischmeyer; Jacob N Schroder; Chetan B Patel; Mani A Daneshmand; Robert N Sladen; Kamrouz Ghadimi Journal: J Cardiothorac Vasc Anesth Date: 2018-08-09 Impact factor: 2.628