Author + information
- Received December 16, 2019
- Revision received January 28, 2020
- Accepted January 28, 2020
- Published online March 30, 2020.
- Arvind Bhimaraj, MD, MPHa,∗ (, )
- Tanushree Agrawal, MDb,
- Antonio Duran, MDb,
- Omar Tamimi, MBBSb,
- Javier Amione-Guerra, MBBSc,
- Barry Trachtenberg, MDa,
- Ashrith Guha, MD, MPHa,
- Imad Hussain, MBBSa,
- Ju Kim, MDa,
- Mahwash Kassi, MBBSa,
- Jiaqiong Xu, PhDa,
- Erik Suarez, MDa,
- Uy Q. Ngoa,
- Guillermo Torre-Amione, MD, MPHa and
- Jerry D. Estep, MDd
- aHouston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
- bDepartment of Internal Medicine, Houston Methodist Hospital, Houston, Texas
- cDepartment of Internal Medicine, University of Texas Health Science Center, San Antonio, Texas
- dKaufman Center for Heart Failure and Recovery, Cleveland Clinic Foundation, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Arvind Bhimaraj, Weill College of Medicine, Cornell University, Houston Methodist Hospital, 6550 Fannin Street, Suite 1901, Houston, Texas 77030.
Objectives This study presents the largest clinical experience of percutaneously placed axillary intra-aortic balloon pump (IABP) in patients with advanced heart failure.
Background Transfemoral placement of IABP limits mobility and recuperation in patients who need prolonged support. We had previously reported a novel percutaneous method of IABP placement in the axillary artery and now present our expanded experience with this technique.
Methods We performed a retrospective chart review of patients with advanced heart failure with percutaneous axillary IABP placement from November 2007 to June 2018 at Houston Methodist Hospital. We defined successful cardiac replacement therapy as heart transplant or left ventricular assist device implantation. We compared patients who had successful cardiac replacement with those who died and those who needed unplanned escalation of mechanical circulatory support.
Results Of the 195 patients identified, 133 (68%) underwent successful cardiac replacement (120 transplants and 13 left ventricular assist device) as planned. End-organ function improved on IABP support in patients bridged to next therapy. There were 16 patients that died while on IABP support and 18 needed escalation of support. Higher right atrial/wedge ratio, higher right atrial pressure, smaller left ventricular end diastolic dimension, and ischemic cardiomyopathy were associated with death on the IABP in multivariate analysis. Post-transplant and post left ventricular assist device survival for those bridged successfully was 87% and 62%, respectively. Although bedside repositioning was frequent, 37% needed replacement for malfunction. Vascular complications occurred in a minority.
Conclusions Percutaneous axillary approach for IABP placement is a feasible strategy for prolonged mechanical circulatory support in patients with advanced heart failure.
- advanced heart failure
- axillary intra-aortic balloon pump
- cardiogenic shock
- mechanical circulatory support
Dr. Bhimaraj is a consultant for Abbott and Abiomed. Dr. Guha serves on the Speakers Bureau for Abbott. Dr. Estep is a consultant for Maquet Getinge Group and Abbott; and serves on the Medical Advisory Board for Medtronic Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 16, 2019.
- Revision received January 28, 2020.
- Accepted January 28, 2020.
- 2020 American College of Cardiology Foundation
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