Ambulatory femoral versus axillary intra-aortic balloon pump support as a bridge to advanced heart failure therapies: Insights from a single-center experience.

BACKGROUND

Ambulatory intra-aortic balloon pump (IABP) support is increasingly used to preserve mobility in patients with advanced heart failure awaiting heart transplantation or left ventricular assist device therapy. Axillary IABP facilitates ambulation but is associated with device-related complications. Structured ambulatory femoral IABP protocols have emerged as an alternative; however, direct comparisons of clinical and functional outcomes are lacking.

OBJECTIVES

To compare safety, device-related complications, and functional mobility between ambulatory axillary and ambulatory femoral IABP support.

METHODS

This retrospective single-center study included consecutive patients receiving axillary (2015-2021) or ambulatory femoral (2022-2025) IABP as a bridge to advanced heart failure therapies. Clinical outcomes, vascular and device-related complications, and 30-day events were abstracted from electronic medical records. Functional mobility was assessed using standardized physical therapy evaluations and session-level ambulation metrics.

RESULTS

Forty-one patients were included (22 axillary, 19 femoral). In-hospital mortality (0% vs 5.6%; p = 0.459) and 30-day mortality (0% vs 5.6%; p = 0.467) were similar. Rates of major bleeding, vascular complications, hematoma, and bacteremia did not differ. Device failure patterns were comparable, including balloon migration (15.0% vs 21.1%; p = 0.685), catheter kink (9.1% vs 5.3%; p = 1.000), and balloon rupture (0% in both groups). Persistent alarms from suboptimal augmentation were more frequent with axillary IABP (59.1% vs 21.1%; p = 0.025). Mean ambulation distances were similar (421.2 ± 318.4 ft vs 374.5 ± 304.9 ft; p = 0.63), with comparable standardized mobility scores.

CONCLUSION

Ambulatory femoral and axillary IABP strategies may provide similar safety profiles and enable functional mobility in carefully selected patients bridged to advanced heart failure therapies.