Vanderbilt Heart and Vascular Institute, Nashville, TN, USA.
J Thorac Cardiovasc Surg. 2012 May;143(5):1193-7. doi: 10.1016/j.jtcvs.2012.02.009. Epub 2012 Feb 24.
Axillary intra-aortic balloon pump therapy has been described as a bridge to transplant. Advantages over femoral intra-aortic balloon pump therapy include reduced incidence of infection and enhanced patient mobility. We identified the patients who would benefit most from this therapy while awaiting heart transplantation.
We conducted a single-center, retrospective observational study to evaluate outcomes from axillary intra-aortic balloon pump therapy. These included hemodynamic parameters, duration of support, and success in bridging to transplant. We selected patients on the basis of history of sternotomy, elevated panel-reactive antibody, and small body habitus. Patients were made to ambulate aggressively beginning on postoperative day 1.
Between September 2007 and September 2010, 18 patients underwent axillary intra-aortic balloon pump therapy. All patients had the devices placed through the left axillary artery with a Hemashield side graft (Boston Scientific, Natick, Mass). Before axillary placement, patients underwent femoral placement to demonstrate hemodynamic benefit. Duration of support ranged from 5 to 63 days (median = 19 days). There was marked improvement in ambulatory potential and hemodynamic parameters, with minimal blood transfusion requirements. There were no device-related infections. Some 72% of the patients (13/18) were successfully bridged to transplantation.
Axillary intra-aortic balloon pump therapy provides excellent support for selected patients as a bridge to transplant. The majority of the patients were successfully bridged to transplant and discharged. Although this therapy has been described in previous studies, this is the largest series to incorporate a regimen of aggressive ambulation with daily measurements of distances walked.
腋动脉内置主动脉球囊反搏泵治疗已被描述为移植桥。与股动脉内置主动脉球囊反搏泵治疗相比，它具有感染发生率降低和提高患者活动能力的优势。我们确定了在等待心脏移植时最受益于这种治疗的患者。
我们进行了一项单中心回顾性观察性研究，以评估腋动脉内置主动脉球囊反搏治疗的结果。这些结果包括血流动力学参数、支持时间和移植桥接的成功率。我们根据胸骨切开术史、升高的面板反应性抗体和较小的体型选择患者。患者从术后第 1 天开始积极行走。
2007 年 9 月至 2010 年 9 月期间，18 名患者接受了腋动脉内置主动脉球囊反搏治疗。所有患者均通过左腋动脉和 Hemashield 侧支移植物（波士顿科学公司，马萨诸塞州纳提克）放置了这些设备。在腋动脉放置之前，患者接受了股动脉放置以证明血流动力学益处。支持时间从 5 天到 63 天不等（中位数为 19 天）。活动能力和血流动力学参数明显改善，输血需求最小。没有与设备相关的感染。大约 72%的患者（13/18）成功桥接移植。
腋动脉内置主动脉球囊反搏泵治疗为选定的患者提供了作为移植桥接的出色支持。大多数患者成功桥接移植并出院。尽管这种治疗在以前的研究中已经描述过，但这是最大的系列研究，其中包括积极行走的方案，并每天测量行走的距离。
