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.
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.
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).
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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© 2019 Published by Elsevier Inc.