Outcomes and Complications of Axillary Intra-Aortic Balloon Pump Support: A Single-Center Experience

Axillary intra-aortic balloon pump (axi-IABP) support has emerged as an alternative to femoral access for patients with advanced heart failure, offering improved mobility and potential benefits in pretransplant conditioning; however, data on associated complications remain limited. We conducted a retrospective study of 55 patients who underwent axi-IABP placement between January 2019 and July 2025 at our institution. The cohort had a median age of 59 (interquartile range [IQR], 52-65) years and presented with cardiogenic shock requiring mechanical circulatory support (MCS). Axi-IABP successfully bridged 87.3% of patients to advanced therapies. A total of 83 complications were identified in 60.0% of patients, most commonly malposition in 23.6% of patients, gas leak alarms in 16.4% of patients, and kinking in 16.4% of patients. Serious vascular complications were infrequent. The median time to first complication was 10.5 (IQR, 2.75-25.5) days. Female sex was associated with a higher hazard of first complication when controlled for height (adjusted hazard ratio [HR] = 2.75, 95% confidence interval [CI] = 1.04-7.27; p = 0.041). In conclusion, axi-IABP is an effective bridging strategy that enhances patient mobility but is associated with a high rate of device-related complications, predominantly mechanical in nature, underscoring the importance of careful patient selection and monitoring.