Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.
Department of Internal Medicine, Houston Methodist Hospital, Houston, Texas.
JACC Heart Fail. 2020 Apr;8(4):313-323. doi: 10.1016/j.jchf.2020.01.011.
This study presents the largest clinical experience of percutaneously placed axillary intra-aortic balloon pump (IABP) in patients with advanced heart failure.
Transfemoral placement of IABP limits mobility and recuperation in patients who need prolonged support. We had previously reported a novel percutaneous method of IABP placement in the axillary artery and now present our expanded experience with this technique.
We performed a retrospective chart review of patients with advanced heart failure with percutaneous axillary IABP placement from November 2007 to June 2018 at Houston Methodist Hospital. We defined successful cardiac replacement therapy as heart transplant or left ventricular assist device implantation. We compared patients who had successful cardiac replacement with those who died and those who needed unplanned escalation of mechanical circulatory support.
Of the 195 patients identified, 133 (68%) underwent successful cardiac replacement (120 transplants and 13 left ventricular assist device) as planned. End-organ function improved on IABP support in patients bridged to next therapy. There were 16 patients that died while on IABP support and 18 needed escalation of support. Higher right atrial/wedge ratio, higher right atrial pressure, smaller left ventricular end diastolic dimension, and ischemic cardiomyopathy were associated with death on the IABP in multivariate analysis. Post-transplant and post left ventricular assist device survival for those bridged successfully was 87% and 62%, respectively. Although bedside repositioning was frequent, 37% needed replacement for malfunction. Vascular complications occurred in a minority.
Percutaneous axillary approach for IABP placement is a feasible strategy for prolonged mechanical circulatory support in patients with advanced heart failure.
本研究介绍了在晚期心力衰竭患者中经皮放置腋动脉内主动脉球囊反搏（IABP）的最大临床经验。
经股动脉放置 IABP 会限制需要长时间支持的患者的活动能力和康复。我们之前曾报道过一种经皮腋动脉 IABP 放置的新方法，现在我们介绍该技术的扩展经验。
我们对 2007 年 11 月至 2018 年 6 月在休斯顿卫理公会医院接受经皮腋动脉 IABP 置入的晚期心力衰竭患者进行了回顾性图表审查。我们将成功的心脏替代治疗定义为心脏移植或左心室辅助装置植入。我们比较了成功进行心脏替代的患者与死亡患者以及需要计划外升级机械循环支持的患者。
在确定的 195 例患者中，133 例（68%）按计划成功进行了心脏替代（120 例心脏移植和 13 例左心室辅助装置）。在桥接到下一种治疗方法的患者中，IABP 支持下的终末器官功能得到改善。有 16 例患者在 IABP 支持下死亡，18 例需要升级支持。多变量分析显示，右心房/楔压比值较高、右心房压力较高、左心室舒张末期内径较小和缺血性心肌病与 IABP 死亡相关。成功桥接的患者在移植后和左心室辅助装置后生存分别为 87%和 62%。尽管经常进行床边重新定位，但 37%的患者因故障需要更换。血管并发症发生率较低。
经皮腋动脉入路放置 IABP 是晚期心力衰竭患者进行长时间机械循环支持的一种可行策略。
