Abstract Body (Do not enter title and authors here): Introduction: Axillary intra-aortic balloon pumps (IABPs) represent an emerging approach to support patients with advanced heart failure, particularly those awaiting heart transplantation. However, data on their safety and effectiveness remain limited. This study aims to evaluate the potential benefits and adverse effects of axillary IABP support through a single-arm meta-analysis.

Research Question: What are the safety outcomes and clinical benefits of axillary intra-aortic balloon pump (IABP) support in patients with advanced heart failure?

Methodology: A systematic search of PubMed, EMBASE, Cochrane Library, and ScienceDirect was conducted to identify observational studies reporting outcomes of axillary or subclavian intra-aortic balloon pump (IABP) placement in patients with advanced heart failure. Primary outcomes were IABP success, mortality, and the need for exchange or repositioning. Secondary outcomes included infection, cerebrovascular accidents (CVA), and limb ischemia. A random-effects model was used to calculate pooled proportions with 95% confidence intervals. Statistical analyses were performed using RStudio with the meta package.

Results: We included nine studies comprising 584 patients who underwent axillary/subclavian IABP (males: 453; females: 132). Pooled mean duration of IABP support was 21.49 days (95% CI: 14.65-28.33). Etiologically, 34% of the patients had ischemic cardiomyopathy, while 53.67% had nonischemic cardiomyopathy. Overall success of IABP was reported in eight studies, which showed a proportion of 0.77 (95% CI: 0.57-0.89). Subgroup analysis revealed that 67% of patients proceeded to successful transplantation (0.67; 95% CI: 0.58-0.75), whereas 6% of patients underwent implantation of left ventricular assist devices. Only 4% of deaths were reported (0.04; 95% CI: 0.01-0.07). The pooled rate of IABP exchange or repositioning was 25% (95% CI: 7%–41%). Re-exploration was performed in 6% of patients (0.06; 95% CI: 0.00–0.11). Pooled proportions for secondary outcomes were: CVA events 0.02 (95% CI: 0.01–0.04), infection 0.01 (95% CI: 0.00–0.02), and limb ischemia 0.01 (95% CI: 0.00–0.03).

Conclusion: Axillary/subclavian IABP is a feasible and effective bridging strategy in advanced heart failure, showing high transplant success and low mortality. Despite a notable rate of device-related procedural revisions, serious complications were rare.