Axillary Intra-Aortic Balloon Pump: From Technical Feasibility to Preserving Functional Capacity

Temporary mechanical circulatory support has become an essential component in the management of advanced heart failure (HF), particularly for patients with progressive hemodynamic deterioration awaiting heart transplantation or other definitive therapies. Although higher-support devices, such as the Impella® and venoarterial extracorporeal membrane oxygenation, have broadened therapeutic options, the intra-aortic balloon pump (IABP) continues to play an important role owing to its widespread availability, lower cost, well-established safety profile, and technical simplicity. These characteristics make it especially valuable in healthcare systems with limited resources, such as Brazil’s.

However, the femoral approach—the most commonly used access route—has an important drawback: it severely limits patient mobility. Prolonged bed rest contributes to skeletal muscle loss, frailty, and declining functional capacity, all of which are associated with poorer outcomes following heart transplantation. Preserving mobility has therefore evolved from a rehabilitation goal into a key therapeutic objective in patients with advanced HF. Against this background, the study published in this issue of the Arquivos Brasileiros de Cardiologia reports the first Brazilian experience with percutaneous axillary IABP implantation in hospitalized heart transplant candidates. Even during the initial learning curve, the investigators achieved technical success in every procedure, with a median support duration of 15 days and complication rates comparable to those reported by experienced international centers, demonstrating that the technique can be safely adopted in specialized advanced HF programs.

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