Ambulatory Intra Aortic Balloon Pump in Advanced Heart Failure

Abstract

Cardiac transplantation is the gold standard treatment for patients with advanced congestive heart failure that is refractory to maximal medical therapy. However, donor heart availability remains the major limiting factor, resulting in a large number of patients waiting long periods of time before transplantation. As a result, mechanical circulatory support devices have been increasingly used as a 'bridge' in order to sustain organ function and stabilise haemodynamics while patients remain on the transplant waiting list or undergo left ventricular assist device surgery. Intra aortic balloon pumps (IABP) are commonly used for temporary circulatory support in patients with advanced heart failure. IABP is traditionally placed percutaneously through the transfemoral artery approach. The major limitation with this approach is ambulatory restriction that can promote deconditioning, particularly in situations of prolonged circulatory support. A subclavian/axillary artery approach IABP insertion allows patients to be ambulatory during the pre-transplant period. In this review, we aim to summarise the physiology of IABP, the evidence for its use in advanced CHF and the efficacy and safety of subclavian artery IABP insertion.

Keywords: Intra aortic balloon pump; advanced heart failure; cardiac transplantation; left ventricular assist device; mechanical circulatory support; subclavian artery intra aortic balloon pump.

Figure 1:. Ambulatory Patient with Left Axillary Artery IABP, Inserted in the Cardiac Catheterisation Laboratory, Awaiting Heart Transplantation and Able to Participate in Physical Therapy