Clinical course and long-term outcome of patients with severe heart failure receiving intra-aortic balloon pump as a bridge to heart transplantation

Purpose: Intra-aortic balloon pump (IABP) is increasingly used among patients with end-stage heart failure (HF) but its efficacy in successfully bridging candidates to heart transplantation (HTx) and effective transplant benefit of patients receiving IABP are unexplored. Herein we compare success rate in achieving HTx and post-transplant survival between transplant candidates who needed IABP support and those stabilized with medical therapy. Methods: All HTx candidates followed between 1998 and 2012 were eligible for this retrospective study. Outcome events were: transplant, death/deterioration while on waiting list, improved and excluded from transplant program. Kaplan Meyer method was used to analyze the occurrence of events. Results: Out of 585 patients included, 35 (6%) needed IABP while 550 (94%) could be managed by medical therapy alone. Mean age was similar in the two groups (50.8±13.5 vs. 50.3±14.4 ys). As expected, need for IABP identified patients at significantly higher risk for mortality (estimated 2-year death rate: 30±3% vs 55±20%, p < 0.01). Of note IABP in progressive deteriorating chronic HF showed 100% mortality rate 3 months after support placement, whereas those who needed IABP for acute HF as initial presentation had 10% death rate during the same span of time. Thanks to listing prioritization, succes rate in achieving HTX in IABP patients was similar to medically treated, with about 80% of patients transplanted in both groups. Importantly, ten-year estimated post-transplant survival was similar in the two groups (68±3 vs. 60±15%, p=0.8; Figure 1). ![Figure][1] Figure 1. Post-transplant survival: IABP vs. noIABP Conclusions: Need for IABP identifies very high mortality risk, in particular for chronic decompensated candidates, but it is a successful strategy as a bridge to HTx and does not limit long-term survival after transplant. [1]: pending:yes