title: The Subclavian Intraaortic Balloon Pump: A Compelling Bridge Device for Advanced Heart Failure.
abstract: BACKGROUND
  A subclavian intraaortic balloon pump (SC-IABP) can help to optimize patients with advanced congestive heart failure as a bridge to definitive therapy. We retrospectively reviewed our experience to assess the application and safety of this technique.
  
  
  METHODS
  We studied 88 patients with decompensated advanced congestive heart failure who received SC-IABP placement between January 2011 and December 2014. The SC-IABP was placed through a graft in the subclavian artery. The intended therapeutic goals for SC-IABP were bridge to transplant (n = 61), mechanical circulatory support (n = 21), or recovery (n = 6). Success was defined as stroke-free survival, achievement of therapeutic goal, and maintenance or improvement in renal function, hemodynamics, and physical conditioning through ambulation and rehabilitation.
  
  
  RESULTS
  Eighty patients were successfully bridged to the next therapy (transplant 93.4%, mechanical circulatory support 95.3%, recovery 50%). There was no mortality related to SC-IABP placement. Duration of SC-IABP support was 4 to 135 days (median 21). Failure was attributed to escalation of support (n = 5), stroke (n = 2), and sepsis (n = 1). Mean pulmonary artery pressure significantly improved from 33 ± 11 mm Hg to 28 ± 8 mm Hg (p < 0.05). Eighty-four patients (95.5%) ambulated more than 3 times a day. Two-minute step test demonstrated significant improvement, from 50 ± 9 steps to 90 ± 23 steps (n = 16, p < 0.001). Specific complications of SC-IABP included exchange/repositioning (n = 26, 29.5%), subclavian artery thrombosis (n = 1, 1.1%), and reexploration for hematoma (n = 4, 4.5%) and infection (n = 2, 2.3%). No distal thromboembolic events were observed.
  
  
  CONCLUSIONS
  The SC-IABP provided excellent hemodynamic support with minimal morbidity and mortality, allowed for extensive rehabilitation, and permitted more than 90% of patients to receive their intended therapy. Therefore, SC-IABP is a compelling bridge device for patients with advanced congestive heart failure.
authors.affiliation: Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Akiko
authors.initials: A
authors.lastname: Tanaka
authors.affiliation: Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Sampura M
authors.initials: SM
authors.lastname: Tuladhar
authors.affiliation: Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
authors.forename: David
authors.initials: D
authors.lastname: Onsager
authors.affiliation: Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Zewditu
authors.initials: Z
authors.lastname: Asfaw
authors.affiliation: Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Takeyoshi
authors.initials: T
authors.lastname: Ota
authors.affiliation: Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Colleen
authors.initials: C
authors.lastname: Juricek
authors.affiliation: Department of Therapy Services, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Meghan
authors.initials: M
authors.lastname: Lahart
authors.affiliation: Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Vassyl A
authors.initials: VA
authors.lastname: Lonchyna
authors.affiliation: Department of Medicine, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Gene
authors.initials: G
authors.lastname: Kim
authors.affiliation: Department of Medicine, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Savitri
authors.initials: S
authors.lastname: Fedson
authors.affiliation: Department of Medicine, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sayer
authors.affiliation: Department of Medicine, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
authors.affiliation: Department of Surgery, University of Chicago Medicine, Chicago, Illinois. Electronic address: jeevan@uchicago.edu.
authors.forename: Valluvan
authors.initials: V
authors.lastname: Jeevanandam
mesh_terms: D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013348:Subclavian Artery; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents