Versatility of the Axillary Intra-Aortic Balloon Pump in Adult Cardiac Surgery

The axillary intra-aortic balloon pump (ax-IABP) has been proposed as an alternative to the femoral IABP, particularly for patients with comorbidities rendering them unsuitable for fem-IABP insertion. Patient mobilisation with the ax-IABP in situ is deemed an additional potential benefit. We reviewed our experience with the ax-IABP. A single-centre retrospective review of all adult patients undergoing cardiac surgery (including heart transplantation) in a UK quaternary cardiac surgery centre between 2017 and 2021 was undertaken. During the study period a total of 232 IABPs were inserted, of which 2.2% (n = 5) were ax-IABPs. Overall in-hospital mortality for this cohort was 19.9% (n = 46). Amongst the five patients who received an ax-IABP, the mean age was 57.4 years, and three patients were female. All patients received an ax-IABP through the right axillary artery via a Dacron side graft. Appropriate positioning was confirmed with real-time fluoroscopy and transoesophageal echocardiography. Operations included heart transplantation (n = 1), coronary artery bypass grafting (CABG) (n = 1), CABG & mitral valve surgery (n = 2) and CABG & mitral & aortic valve surgery (n = 1). No patient experienced IABP-related morbidity and three patients survived to discharge. In this limited series, ax-IABP has emerged as a reasonable alternative to fem-IABP. Several patients in this series who received an ax-IABP were not suitable for fem-IABP. The absence of IABP-related morbidity in this series supports the usage of ax-IABP as an appropriate alternative treatment for patients requiring IABP support.