P56: The Impact of Ipsilateral Implantable Cardioverter Defibrillator in Axillary Intra-Aortic Balloon Pump Support as Bridge-to-Heart Transplantation

Background: The axillary artery (AX) access for intra-aortic balloon pump (IABP) as a bridge to heart transplant (HT) allows mobility while awaiting a suitable donor. As end-stage heart failure patients often have an implantable cardioverter defibrillator (ICD) on the left side, the left AX approach may be avoided due to the perception of difficult access and proximity of two devices. Purpose: We compare the outcomes of patients undergoing HT that were bridged with a left-sided AX IABP with or without ipsilateral ICDs. Methods: Patients who had undergone left AX IABP as a bridge to HT between January 2010 to February 2022 were retrospectively reviewed (N=31). All AX IABPs were surgically implanted via the left AX. ICD was present in a total of 17 (80.9%) on the left side (Group ICD) while 14 patients did not have ICD on the left side (Group No-ICD). The procedural time was defined as the time from skin incision to the beginning of anastomoses of a Dacron graft. Results: The median age of the recipients was 55.6±12.9 with 80.6% (N=25) males. The median duration of left AX IABP support was 14 (8,22) days. Technical success was 100%. The mean procedure time to expose the AX was comparable between the two groups (ICD, 12.5±6.2 min vs. No-ICD, 11.2±6.0 min, P=0.640), as was the incidence of bleeding/hematoma (ICD, 0% vs. No-ICD, 7.1%, P=0.202). There was no ischemic stroke in both group. The most common adverse event in the cohort was a malfunction in 4 patients (12.9%) and malposition requiring exchange in 2 patients (6.4%). There was AX hematoma in 1 patient requiring revision and 1 patient with a right-sided ICD who had peripheral vascular disease developed left-sided arm and lower limb ischemia. Neither group had no device-related infection, wound infection, or brachial plexus symptoms. Conclusion: The insertion of IABP via the left AX as a bridge to HT is feasible with a good safety profile. The left AX approach for patients with ipsilateral ICDs can also be performed safely without increasing procedure time and adverse events.