Axillary IABP support enables ambulation in most heart failure patients with low complication rates.

This systematic review and meta-analysis included four retrospective studies of patients with heart failure who received axillary intra-aortic balloon pump (IABP) support, with traditional transfemoral insertion implied as an alternative. The primary outcome was ambulation, and secondary outcomes included vascular complications, stroke, infection, bleeding, and device failure. The sample size was not explicitly reported beyond the number of studies, and follow-up, setting, and funding details were not provided.

For ambulation, most patients were able to ambulate, with an effect size of 0.928 (95% CI: 0.811–0.999). Adverse events showed low incidences: vascular complications had an effect size of 0.059 (95% CI: 0.001–0.137), stroke 0.022 (95% CI: 0.001–0.044), infection 0.037 (95% CI: 0.001–0.106), and bleeding 0.028 (95% CI: 0.005–0.052). Device failure, including kinking, rupture, migration, or malposition, was the most frequent adverse event with an effect size of 0.314 (95% CI: 0.224–0.404). Absolute numbers for these outcomes were not reported.

Safety and tolerability were described as having an overall favorable profile, with adverse events including device failure, vascular complications, stroke, infection, and bleeding. Serious adverse events and discontinuations were not reported. Key limitations include a relatively high rate of device failure, and the retrospective nature of the studies may introduce bias. Practice relevance suggests axillary IABP support is a feasible bridge to advanced heart failure therapies, enabling ambulation in most patients and facilitating transition to definitive treatment, but this should be interpreted cautiously given the evidence base.