Ambulating Patients with Femoral Intra-Aortic Balloon Pump as Bridge to Heart Transplant - A Case Series

Introduction Patients with end stage HF not responsive to GDMT are often referred for OHT. IABP are often utilized to support these patients as a bridge. Frailty has been shown to correlate with increased morbidity in such patients. Gait speed is well described in the frailty phenotype in patients with HF. We postulate that interventions to prevent or treat frailty may result in better outcomes after OHT. To that end, our center has an aggressive physical and occupational therapy program in place to assist patients with ambulation and improvement in gait speed prior to surgery. To date, no published literature describes the efficacy of ambulation in patients with femoral IABP. We review the feasibility of ambulation on femoral IABP for patients who eventually underwent OHT at our center. Methods A retrospective analysis was performed from January 2018-March 2019, which identified four patients with advanced HF who ambulated with femoral IABP prior to OHT. A KREG catalyst standing bed was utilized to advance patients (with femoral IABP) from supine immobility to in-bed tilting, standing, and finally, ambulating off the bed and into the environment with a rolling walker. The first patient was a 26 year old male with HOCM who presented in acute cardiogenic shock. He was optimized with inotropes and had a femoral IABP in place for 128 days prior to OHT. The patient progressed from standing to ambulating, and his preoperative gait speed improved from 0.23 to 1.21 m/s. He had one episode of minor bleed at the site of IABP which resolved with localized pressure. No other complications occurred. The second patient was a 58 year old male with dilated cardiomyopathy on inotropes. He had a femoral IABP for 21 days prior to OHT. He progressed from in-bed standing to ambulating, reaching a preoperative gait speed of 0.46 m/s. No complications occurred. The third patient was a 59 year old male with ICM on inotropes and high-dose diuretics. He had a femoral IABP for 43 days and improved his gait speed from 0.56 to 1.43 m/s. His IABP was displaced once, requiring a device exchange, but no other complications occurred. The fourth patient was a 38 year old male with restrictive cardiomyopathy on inotropic support. He was supported by a femoral IABP for 9 days prior to OHT and progressed from in-bed standing to ambulating, reaching a preoperative gait speed of 0.46 m/s. No complications occurred. All patients did well post-transplant. Average post-operative length of stay was 31 days. All patients walked more than 1000 feet prior to discharge. Conclusions From our small sample size of four patients ambulating with femoral IABP who eventually underwent OHT, we believe ambulation of such patients is safe and feasible. A larger sample size is needed to establish which patients are safe for ambulation with a femoral IABP and if this method can improve patient outcomes.