The Single Access Technique (Sat) for Impella Cp® Protected Percutaneous Coronary Interventions (Pci): A Single Center Experience

Gajanan, Ganesh; Asawaeer, Majid; Chatzizisis, Yiannis S.; Goldsweig, Andrew M.; Velagapudi, Poonam; O’Leary, Edward; Barton, David

doi:10.1016/s0735-1097(20)31961-6

Cited by 3 publications

(7 citation statements)

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“…Many operators including ourselves started using 6-7 Fr thin-wall Slender sheath that are usually used for the transradial approach. 4 While it facilitates the insertion of the sheath next to the Impella shaft compared to a regular 7F sheath, therefore reducing interaction with the pump, it can only accommodate a 7F guide. Although sheath fracture or partial sheath loss have not been described or encountered so far, compression of the thin-walled sheath sometimes occur and will limit the ease of movement of the guide into the sheath.…”

Section: Discussionmentioning

confidence: 99%

“…Despite hydrophilicity, the 7 Fr sheath would interact substantially with the Impella device, sometimes causing its displacement. Many operators including ourselves started using 6–7 Fr thin‐wall Slender sheath that are usually used for the transradial approach 4 . While it facilitates the insertion of the sheath next to the Impella shaft compared to a regular 7F sheath, therefore reducing interaction with the pump, it can only accommodate a 7F guide.…”

Section: Discussionmentioning

confidence: 99%

“…The SHiP technique has been refined over the latest years with the use of thin‐wall 6–7 Fr radial sheaths, that have the outer diameter of a 6 Fr regular sheath but can accommodate a 7 Fr guide 4 . Use of those thin‐wall (Terumo, Tokyo, Japan, or Merit Medical) radial sheaths significantly reduced the interaction between the Impella shaft and the sheath through the 14 Fr sheath and has minimized the problem of pump movement with catheter movement.…”

Section: Introductionmentioning

confidence: 99%

“…The SHiP technique has been refined over the latest years with the use of thin-wall 6-7 Fr radial sheaths, that have the outer diameter of a 6 Fr regular sheath but can accommodate a 7 Fr guide. 4 Use of those thin-wall (Terumo, Tokyo, Japan, or Merit Medical) radial sheaths significantly reduced the interaction between the Impella shaft and the sheath through the 14 Fr sheath and has minimized the problem of pump movement with catheter movement. Given the fact that the outer diameter of a 6 Fr sheath is the same as the outer diameter of an 8 Fr guide, and considering the already known successful technique of transradial sheathless technique using 8 Fr guide, 5 we were able to deliver an 8 Fr guide in similar fashion next to the Impella shaft.…”

mentioning

confidence: 99%

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Single‐access for Impella‐supported percutaneous coronary intervention using a sheathless technique with an 8 Fr guide

Verreault-Julien

Shekiladze

Wollmuth

et al. 2022

Cathet Cardio Intervent

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Complex and higher-risk indicated percutaneous coronary interventions at times require mechanical circulatory support, most often with Impella devices. The use of such devices traditionally required additional arterial access site(s), increasing risk of vascular complications. The Single-access for Hi-risk percutaneous coronary intervention (SHiP) technique was described to overcome this issue but was limited to the use of 7F guides. Larger 8F guides often provide incremental support and space compared to 7F guides, sometimes needed in complex procedures. We described a modified SHiP technique using an 8 Fr guide delivered sheathless using Rotaglide.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Single‐access for Impella‐supported percutaneous coronary intervention using a sheathless technique with an 8 Fr guide

Verreault-Julien

Shekiladze

Wollmuth

et al. 2022

Cathet Cardio Intervent

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“…Traditionally, the introduction of the Impella pump was associated with dual arterial access sites, one for Impella insertion and another for PCI. It is now feasible to perform Impella‐assisted PCI via a single access through the 14 F peel‐away sheath 37 . Associated with a lower risk of complications, single access is gaining popularity, 37 although there are no official recommendations at this time.…”

Section: Roadmap Towards a High‐risk Percutaneous Coronary Interventi...mentioning

confidence: 99%

Roadmap towards an institutional Impella programme for high‐risk coronary interventions

et al. 2023

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Coronary artery disease (CAD) and its complications remain the main cause of morbidity and mortality worldwide. Patients with extensive CAD and multiple comorbidities who require complex, high‐risk percutaneous coronary intervention (HR‐PCI) are at risk of haemodynamic instability and may require short‐term mechanical circulatory support (MCS) during the procedure to maintain sufficient perfusion and prevent ischaemia. Impella is a microaxial continuous blood flow pump used for percutaneous support of the left ventricle in patients undergoing HR‐PCI. Data from randomized controlled trials and registries suggested an advantage for Impella devices in patients undergoing HR‐PCI, compared with other types of MCS. As a thorough understanding of the benefits and drawbacks of the Impella technology is crucial for patient outcomes, we provide a technological overview of Impella and share our experiences gathered during the implementation of institutional Impella programmes in Poland as a roadmap of selection and periprocedural care for patients treated with Impella in the setting of HR‐PCI. We propose 10 steps for implementation of an institutional Impella programme for HR‐PCI, including (i) dedicated staff training; (ii) standard operating procedure and troubleshooting algorithms prior to the first intervention; (iii) patient selection by the multidisciplinary Heart Team; (iv) patient preparation using multimodality imaging; (v) procedure planning in terms of large‐bore access, equipment, and complete revascularization; (vi) starting with HR‐PCI support; (vii) starting with femoral artery access in a patient without extensive peripheral artery disease; (viii) multidisciplinary care after the procedure; (ix) haemodynamic and laboratory monitoring to ensure immediate diagnosis of access‐site complications, bleeding, haemolysis, acute kidney injury, and infections; and (x) careful revision of every HR‐PCI case with the team.

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Protected high risk percutaneous coronary intervention—Impella 5.0 as a single-access technique: a case report

Medina,

Wenzel,

Fathallah

et al. 2024

European Heart Journal - Case Reports

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Background Patients requiring coronary intervention after acute myocardial infarction, with decompensated heart failure and multiple comorbidities, present a challenging clinical scenario. Addressing such high-risk cases has been a marked increase in the simultaneous support using microaxial flow pump devices, providing a crucial hemodynamic support during procedures. Case summary We report the case of a 58-year-old man, with a non-ST-segment elevation myocardial infarction in the context of a peripheral vascular surgery. Echocardiography revealed severely reduced left ventricular function and cardiac-MRI demonstrated transmural scars in all but left anterior descending artery area. Patient was of extreme high surgical risk due to the multiple comorbidities, acute decompensation heart failure and peripheral artery disease and, therefore, the heart team preferred protected percutaneous coronary intervention (PCI) over coronary artery bypass graft for revascularization. The peripheral artery disease included severely calcified ascending aorta, occlusions of both femoral arteries, the left subclavian artery, and right radial artery. Taken together, the heart team agreed on a hybrid approach with surgical implantation of Impella 5.0 via the left subclavian artery, by a single access technique. Following the intervention procedure, hemostasis of the vascular prosthesis was achieved by an Angio-Seal technique without complications. The patient recovered satisfactorily, with improved left ventricular function and discharged ten days post-procedure. Discussion The Single-access for high-risk PCI technique offers a standardized approach for microaxial flow pump devices such as Impella 5.0 and PCI. The subclavian artery as a single-access route for high-risk PCI, has demonstrated safety and efficacy.

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The Single Access Technique (Sat) for Impella Cp® Protected Percutaneous Coronary Interventions (Pci): A Single Center Experience

Cited by 3 publications

References 0 publications

Single‐access for Impella‐supported percutaneous coronary intervention using a sheathless technique with an 8 Fr guide

Single‐access for Impella‐supported percutaneous coronary intervention using a sheathless technique with an 8 Fr guide

Roadmap towards an institutional Impella programme for high‐risk coronary interventions

Protected high risk percutaneous coronary intervention—Impella 5.0 as a single-access technique: a case report

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