title: Benefits of ambulatory axillary intra-aortic balloon pump for circulatory support as bridge to heart transplant.
abstract: OBJECTIVE
  Axillary intra-aortic balloon pump therapy has been described as a bridge to transplant. Advantages over femoral intra-aortic balloon pump therapy include reduced incidence of infection and enhanced patient mobility. We identified the patients who would benefit most from this therapy while awaiting heart transplantation.
  
  
  METHODS
  We conducted a single-center, retrospective observational study to evaluate outcomes from axillary intra-aortic balloon pump therapy. These included hemodynamic parameters, duration of support, and success in bridging to transplant. We selected patients on the basis of history of sternotomy, elevated panel-reactive antibody, and small body habitus. Patients were made to ambulate aggressively beginning on postoperative day 1.
  
  
  RESULTS
  Between September 2007 and September 2010, 18 patients underwent axillary intra-aortic balloon pump therapy. All patients had the devices placed through the left axillary artery with a Hemashield side graft (Boston Scientific, Natick, Mass). Before axillary placement, patients underwent femoral placement to demonstrate hemodynamic benefit. Duration of support ranged from 5 to 63 days (median = 19 days). There was marked improvement in ambulatory potential and hemodynamic parameters, with minimal blood transfusion requirements. There were no device-related infections. Some 72% of the patients (13/18) were successfully bridged to transplantation.
  
  
  CONCLUSIONS
  Axillary intra-aortic balloon pump therapy provides excellent support for selected patients as a bridge to transplant. The majority of the patients were successfully bridged to transplant and discharged. Although this therapy has been described in previous studies, this is the largest series to incorporate a regimen of aggressive ambulation with daily measurements of distances walked.
authors.affiliation: Vanderbilt Heart and Vascular Institute, Nashville, TN, USA.
authors.forename: Ramanan
authors.initials: R
authors.lastname: Umakanthan
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Hoff
authors.forename: Natalia
authors.initials: N
authors.lastname: Solenkova
authors.forename: Mark A
authors.initials: MA
authors.lastname: Wigger
authors.forename: Mary E
authors.initials: ME
authors.lastname: Keebler
authors.forename: Andrew
authors.initials: A
authors.lastname: Lenneman
authors.forename: Marzia
authors.initials: M
authors.lastname: Leacche
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Disalvo
authors.forename: Henry
authors.initials: H
authors.lastname: Ooi
authors.forename: Allen J
authors.initials: AJ
authors.lastname: Naftilan
authors.forename: John G
authors.initials: JG
authors.lastname: Byrne
authors.forename: Rashid M
authors.initials: RM
authors.lastname: Ahmad
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000379:methods*; D001366:Axillary Artery; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation; D006439:Hemodynamics; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D020127:Recovery of Function; D012189:Retrospective Studies; D013714:Tennessee; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking; D055815:Young Adult