A systematic review and meta-analysis of axillary intra-aortic balloon pump as a bridge to advanced heart failure therapy

Background: The axillary approach for intra-aortic balloon pump (IABP) placement offers an alternative to traditional transfemoral insertion, with the potential advantage of preserving mobility during temporary mechanical circulatory support. Methods: We performed a systematic review and meta-analysis of four retrospective studies evaluating outcomes in patients who received axillary IABP support. Results: Most patients supported with an axillary IABP were able to ambulate, with a pooled probability of 0.928 (95% CI: 0.811-0.999). The incidences of vascular complications (0.059; 95% CI: 0.001-0.137), stroke (0.022; 95% CI: 0.001-0.044), infection (0.037; 95% CI: 0.001-0.106), and bleeding (0.028; 95% CI: 0.005-0.052) were low. The most frequent adverse event was device failure (including kinking, rupture, migration, or malposition), with a pooled incidence of 0.314 (95% CI: 0.224-0.404). Conclusion: Axillary IABP support is a feasible bridge to advanced heart failure therapies, enabling ambulation in most patients and facilitating transition to definitive treatment. While the overall safety profile is favorable, the relatively high rate of device failure represents a key limitation of this approach.