title: 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: OBJECTIVE
  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.affiliation: The Methodist DeBakey Heart & Vascular Center, Department of Cardiology, Houston, Texas. Electronic address: jestep@houstonmethodist.org.
authors.forename: Jerry D
authors.initials: JD
authors.lastname: Estep
authors.affiliation: The Methodist DeBakey Heart & Vascular Center, Department of Cardiology, Houston, Texas.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Cordero-Reyes
authors.affiliation: The Methodist DeBakey Heart & Vascular Center, Department of Cardiology, Houston, Texas.
authors.forename: Arvind
authors.initials: A
authors.lastname: Bhimaraj
authors.affiliation: The Methodist DeBakey Heart & Vascular Center, Department of Cardiology, Houston, Texas.
authors.forename: Barry
authors.initials: B
authors.lastname: Trachtenberg
authors.affiliation: The Methodist DeBakey Heart & Vascular Center, Department of Cardiology, Houston, Texas.
authors.forename: Nashwa
authors.initials: N
authors.lastname: Khalil
authors.affiliation: The Methodist DeBakey Heart & Vascular Center, Department of Surgery, Houston, Texas.
authors.forename: Matthias
authors.initials: M
authors.lastname: Loebe
authors.affiliation: The Methodist DeBakey Heart & Vascular Center, Department of Surgery, Houston, Texas.
authors.forename: Brian
authors.initials: B
authors.lastname: Bruckner
authors.affiliation: The Methodist DeBakey Heart & Vascular Center, Department of Cardiology, Houston, Texas.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Orrego
authors.affiliation: The Methodist DeBakey Heart & Vascular Center, Department of Surgery, Houston, Texas.
authors.forename: Jean
authors.initials: J
authors.lastname: Bismuth
authors.affiliation: The Methodist DeBakey Heart & Vascular Center, Department of Cardiology, Houston, Texas.
authors.forename: Neal S
authors.initials: NS
authors.lastname: Kleiman
authors.affiliation: 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.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Torre-Amione
mesh_terms: D001366:Axillary Artery; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D013348:Subclavian Artery; D013997:Time Factors
keywords: heart failure; heart transplant; intra-aortic balloon pump; subclavian artery