Outcomes of Patients Bridged to Cardiac Transplant with Subclavian Access Intra-Aortic Balloon Pumps: A Single Center Experience and Matched UNOS Analysis

Abstract

Purpose To describe adverse events associated with subclavian access intra-aortic balloon pump (IABP) before and after cardiac transplant utilizing high level, single center data. In order to assess morbidity associated with IABP use, a matched United Network for Organ Sharing (UNOS) cohort without IABP support was created as a comparison group. Methods The study included two patient groups: 1) patients bridged to cardiac transplant as Status 2 with subclavian access IABP at single center and 2) a UNOS cohort of transplant recipients (between 2014-2018) matched on hemodynamic Status 2 requirements and wait times. Patient characteristics and post-transplant outcomes were compared. Complications specific to the subclavian IABP using the single center data were collected and reported. Results The single center subclavian access IABP cohort included 28 patients and was compared to the matched UNOS cohort of 202 patients. There was no significant difference in age, ischemic cardiomyopathy diagnosis, or wait times between the two cohorts (Table 1). Post-transplant length of stay and need for post-transplant dialysis was higher in the IABP supported patients. The one-year survival probabilities were similar (subclavian IABP: 96%, matched UNOS cohort: 93%, log rank p\u202f=\u202f0.97). Balloon pump repositioning (36%) and replacement (21%) were common. Post-operative infections attributable to the graft site occurred in 17% of patients. Conclusion Patients transplanted on subclavian access IABP had comparable survival at 1 year to a UNOS matched cohort, however IABP re-positioning, replacement and post-operative infections were common. The matched cohort analysis suggests the IABP itself may be associated with longer length of stay and higher rates of post-transplant dialysis, although patient acuity may have accounted for this difference despite hemodynamic matching.