Griffin Boll1, Ariel Fischer1, Navin K Kapur2, Payam Salehi3. 1. Department of Surgery, Tufts Medical Center, Boston, MA. 2. Department of Cardiology, Tufts Medical Center, Boston, MA. 3. Department of Surgery, Tufts Medical Center, Boston, MA. Electronic address: psalehi@tuftsmedicalcenter.org.
Abstract
BACKGROUND: Impella 5.0 is a powerful mechanical circulatory support device placed into the left ventricle of patients in cardiogenic shock not responding to pharmacologic support alone. This therapy can support patient hemodynamics from weeks to several months, and patients can potentially ambulate with the device implanted while awaiting destination therapy. METHODS: From July 2012 to September 2017, 22 Impella 5.0 devices (Abiomed Inc., Danvers, MA) were implanted via right axillary artery at our center. All devices were implanted under fluoroscopic and transesophageal echocardiographic guidance. RESULTS: Eighty-one percent of patients were male, and average age was 61 years (range 27-73). A 10- or 12-mm graft was used in 96% of the cases, most commonly Hemashield (Maquet, Rastatt, Germany; 46%) or Dacron (DuPont, Wilmington, DE; 23%). The graft was tunneled laterally in a subcutaneous plane in 91% of the cases. All attempts at right axillary artery conduit creation and device implantation were successful. The angle of end-to-side anastomosis was 45-60°. The average duration of therapy was 8.8 days (range 1-19). There were no brachial plexus injuries, patients with upper extremity ischemia, or bleeding requiring intervention in the postoperative period. One patient was coagulopathic and developed a hemorrhagic stroke. Concurrent use of mechanical circulatory support for the right heart was present in 27% of the cases. Twenty-seven percent of patients bridged successfully to ventricular assist devices, 18% recovered to have the device explanted, and 55% of patients died within 30 days of device implantation. CONCLUSIONS: Right axillary artery conduit is a safe and reliable access for implantation of Impella 5.0. This technique appears to be associated with low complication rates when implanted with a standardized technique.
BACKGROUND: Impella 5.0 is a powerful mechanical circulatory support device placed into the left ventricle of patients in cardiogenic shock not responding to pharmacologic support alone. This therapy can support patient hemodynamics from weeks to several months, and patients can potentially ambulate with the device implanted while awaiting destination therapy. METHODS: From July 2012 to September 2017, 22 Impella 5.0 devices (Abiomed Inc., Danvers, MA) were implanted via right axillary artery at our center. All devices were implanted under fluoroscopic and transesophageal echocardiographic guidance. RESULTS: Eighty-one percent of patients were male, and average age was 61 years (range 27-73). A 10- or 12-mm graft was used in 96% of the cases, most commonly Hemashield (Maquet, Rastatt, Germany; 46%) or Dacron (DuPont, Wilmington, DE; 23%). The graft was tunneled laterally in a subcutaneous plane in 91% of the cases. All attempts at right axillary artery conduit creation and device implantation were successful. The angle of end-to-side anastomosis was 45-60°. The average duration of therapy was 8.8 days (range 1-19). There were no brachial plexus injuries, patients with upper extremity ischemia, or bleeding requiring intervention in the postoperative period. One patient was coagulopathic and developed a hemorrhagic stroke. Concurrent use of mechanical circulatory support for the right heart was present in 27% of the cases. Twenty-seven percent of patients bridged successfully to ventricular assist devices, 18% recovered to have the device explanted, and 55% of patients died within 30 days of device implantation. CONCLUSIONS: Right axillary artery conduit is a safe and reliable access for implantation of Impella 5.0. This technique appears to be associated with low complication rates when implanted with a standardized technique.
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