Prophylactic intra-aortic balloon pump in transfemoral transcatheter aortic valve implantation

The intra-aortic balloon pump (IABP) has been the most used mechanical circulatory support (MCS) device in the last 40 years. Its utility has been investigated in several clinical settings: cardiogenic shock, myocardial infarction, high-risk percutaneous coronary interventions, left ventricular unloading, and as a bridging strategy to high-risk cardiac surgery. However, no data on the feasibility of temporary MCS with an IABP during transfemoral transcatheter aortic valve implantation (TAVI) are available.

From November 2021 to November 2022, eleven patients with severe aortic stenosis (AS) and a left ventricular ejection fraction (LVEF) <30% (low-flow, low-gradient: n=7) underwent elective transfemoral TAVI with prophylactic transfemoral IABP support. Patients had a median age of 82 years (interquartile range [IQR]: 71.8-85.3), two of the eleven (18%) were female, the median LVEF was 20% (IQR: 18%-25%), and four patients (36%) had known coronary artery disease. Ten balloon-expandable valves (SAPIEN 3 Ultra; Edwards Lifesciences) and one self-expanding valve (Evolut PRO+; Medtronic) were implanted. No patients underwent balloon predilation. Procedural success with no haemodynamic instability or perioperative complications (i.e., cerebrovascular or access-site related complications) was achieved in all patients;...