The Subclavian Intraaortic Balloon Pump: A?Compelling Bridge Device for Advanced Heart?Failure

摘要

Management of Patients With Advanced Congestive Heart FailureOperative TechniqueStatistical AnalysisResultsPatient ManagementPatient OutcomesCommentStudy LimitationsConclusionDiscussionReferencesA 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.MethodsWe 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.ResultsEighty 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.ConclusionsThe 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.Abbreviations and Acronyms: BTMCS (bridge to mechanical circulatory support), BTR (bridge to recovery), BTT (bridge to transplant), CHF (congestive heart failure), IABP (intraaortic balloon pump), LVAD (left ventricular assist device), MCS (mechanical circulatory support), SC (subclavian)Drs Jeevanandam and Uriel disclose a financial relationship with Thoratec Corporation, HeartWare International Inc, and Reliant Heart Inc; Dr Uriel with XDx Inc.Advanced congestive heart failure (CHF), American College of Cardiology/American Heart Association stage D, describes patients with symptoms at rest despite optimal medical therapy [