This is the first time to the authors’ knowledge that a minimally invasive version of the procedure has been reported.
Balloon pumps improve blood flow and are usually used temporarily with patients who are receiving treatment for advanced heart failure and are already very sick. The pumps are used to keep patients alive while they wait for a new heart. Traditionally the pumps are inserted into the aorta through the femoral artery near the leg. But that approach has disadvantages, the doctors said.
“There are problems with that approach,” said Jerry Estep, M.D., the Heart Failure paper’s lead author. “Because of where the incision is, there is going to be a risk of infection, especially for those waiting for a heart because it can be a prolonged ordeal. We think this may be a problem because literature suggests heart failure patients who become immobile can become debilitated easily. Their physical ability is extremely important going into a big surgery like heart transplant.”
Instead, the team of cardiologists and cardiovascular surgeons looked at whether inserting the intra-aorta balloon pump (IABP) through a small incision in the arm’s left axillary-subclavian artery worked better for 50 advanced heart failure patients. The doctors used just needles and wires to perform the procedure. Previous versions of the arm approach, however, have been major surgical procedures involving the cutting and sewing of a graft onto the artery.
Estep and his colleagues reported that the minimally invasive placement of the IABP through the arm was successful in all 50 patients. 46 patients were alive after five months, which is better than the average five month-survival rate of patients who receive an IABP via other means. 42 of the patients were successfully supported long enough to receive a heart transplant, and the 90-day post-transplant survival rate was 90 percent.
All 50 patients received regular walking assistance following placement of the IABP, and among the 42 patients who ultimately received new hearts, the doctors saw a decrease in pulmonary hypertension and improvements in kidney and liver function while waiting for a heart.
Complications to the insertion of the IABP through the arm were limited. Compared to a leg insertion of the IABP, which resulted in about 30 percent post-operative infections, arm insertion resulted in zero infections.
Also contributing to the Heart Failure paper were Andrea M. Cordero-Reyes, M.D., Arvind Bhimaraj, M.D., Barry Trachtenberg, M.D., Nashwa Khalil, Matthias Loebe, M.D., Ph.D., Brian Bruckner, M.D., Carlos M. Orrego, Jean Bismuth M.D., Neal S. Kleiman, M.D., and Guillermo Torre-Amione, M.D., Ph.D.
To speak with Dr. Jerry Estep, please contact David Bricker, Houston Methodist, at 832-667-5811