Surgically tunneled femoral IABP with Dacron graft: novel technique to facilitate rehabilitation before and after cardiac surgery

We present a 52-year-old male with end-stage systolic heart failure secondary to dilated non-ischemic cardiomyopathy and recurrent ventricular tachycardia, requiring cardiac resynchronization therapy defibrillator (CRT-D) and intra-aortic balloon pump (IABP) support for cardiogenic shock. Initially supported with a percutaneous femoral IABP, the patient developed significant lower limb deconditioning. To mitigate this, a surgically placed tunneled Dacron graft IABP was introduced to improve mobility and reduce atrophy, enabling structured prehabilitation while awaiting orthotopic heart transplantation (OHT). This approach allowed for safe ambulation and physical therapy without compromising device function, ultimately enhancing functional status pre-OHT. Post-transplant, he required temporary veno-arterial extracorporeal membrane oxygenation (ECMO) and IABP support for primary graft dysfunction and was eventually weaned off devices. Another case involved a 63-year-old male transferred from an outside hospital (OSH) with 95% left mainstem stenosis and diffuse triple vessel coronary artery disease (preoperative right femoral IABP was placed). After emergency triple vessel coronary artery bypass grafting (CABG), he required left femoral veno-arterial ECMO for poor right ventricular (RV) function. He recovered postoperatively, had subsequent ECMO decannulation and IABP replacement with tunneled graft, and was able to engage in physical therapy, with improvement in upright tolerance. Further research is needed to assess infection risks and validate the promising tunneled Dacron graft technique.