Abstract Body: Background:
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 through a single-arm meta-analysis.
Hypothesis : 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 9 studies, comprising 584 patients who underwent axillary/subclavian IABP (males: 447; females:138). Pooled mean duration for IABP was 21.49 (95% CI: 14.65-28.33). Etiologically, Ischemic cardiomyopathy was diagnosed in 199 (34%) patients while non ischemic cardiomyopathy in 314 (53.67%) patients. Overall success of IABP was reported in 8 studies which showed the proportion of 0.77 (95% CI: 0.57-0.89). The subgroup analysis showed that, 67% patients proceeded to successful transplant (0.67; 95% CI: 0.58-0.75) while 6% patients were gone through left ventricular assisted device (LVAD). Only 4% death was 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 done in 6% patients 0.06 (95 % CI: 0.00- 0.11). Pooled proportions for secondary outcomes were: cerebrovascular 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 complications, serious complications were rare.