Percutaneous sheathless subclavian intra-aortic balloon pump implantation as a bridge to heart transplantation: a feasibility study.

Introduction: Intra-aortic balloon pump (IABP) therapy is a widely used mechanical circulatory support method for patients with advanced heart failure, including those awaiting orthotopic heart transplantation (OHT). Traditional femoral access limits patient mobility and may not be suitable in cases of peripheral artery disease. Aim: This study evaluates the feasibility and safety of a fully percutaneous, sheathless IABP implantation via the left subclavian artery as a bridge to transplantation. Material and methods: Between June and December 2024, 10 patients in critical condition (1 F, 9 M, mean age: 58 years) underwent IABP implantation using ultrasound-guided puncture of the left subclavian artery without surgical exposure. The balloon was inserted sheathless and secured to the chest wall. Device removal was also performed percutaneously with a 6F AngioSeal closure device. Results: Definitive therapy (OHT or LVAD) was achieved in 60% of patients. The mean IABP support duration was 21.6 days (up to 69 days). There were no local access site complications. Two device-related mechanical issues were managed without sequelae. One fatal outcome was potentially related to embolic complications; others were due to progressive multiorgan failure. The subclavian approach preserved femoral access and enabled early mobilization. Conclusions: Sheathless percutaneous subclavian IABP implantation appears to be a feasible and safe strategy for bridging critically ill patients to definitive therapy. It reduces vascular trauma, facilitates patient mobilization, and allows surgical access to be avoided. Further studies in larger cohorts are warranted to confirm these promising results.