Purpose
An intra-aortic balloon pump (IABP) can help optimize and bridge to transplant (BTT)
patients with advanced congestive heart failure. We retrospectively reviewed the application
and safety of this technique at our center.
Methods
Between January 2016 and April 2018, 32 patients underwent IABP as BTT including femoral
(n=11), subclavian (n=17), and axillary (n=4) approaches with a median duration of
support of 5 (IQR 3;14), 18 (IQR 15;36) and 30 (IQR 18;39) days, respectively.
Results
The mean age was 57.5 +/- 9.4 years, 15 (48%) had NICM, and 30 (94%) patients were
in INTERMACS 1&2 profiles. Prolonged IABP support was associated with significant improvements
in mean pulmonary artery pressure (from 35.8 +/- 11.1 to 28.2 +/- 7.9, p=0.02); cardiac
index (from 2.0 +/- 0.5 to 2.5 +/- 0.6, p<0.01), and creatinine (from 1.6 +/- 0.8
to 1.3 +/- 0.7, p=0.04). Overall, three (9%) patients died, 6 (19%) patients received
left ventricular assist device (LVAD), and 23 (72%) patients underwent heart (n=21)
or multi-organ (n=2) transplantation. At 30 days of follow up, Kaplan-Meier survival
was 89%, rate of transplantation 76%, and rate of escalation to LVAD 23%. Complications
of IABP support are listed in Table 1. Complication-free survival was 64% (Figures
1 A, B, C, D).
Conclusion
IABP provides reasonable hemodynamic support for BTT in many patients with end stage
heart failure; however, over one third developed complications of prolonged support.
Further investigation is needed to identify which patients are most appropriate for
BTT IABP.
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Article info
Identification
Copyright
© 2019 Published by Elsevier Inc.
