Use of Impella in Patients Listed for Heart Transplantation

Trivedi, Jaimin R.; Pahwa, Siddharth; Alwair, Hazaim; Whitehouse, Katherine R; Dunbar-Matos, Christina; Slaughter, Mark S.

doi:10.1016/j.healun.2021.01.1778

Cited by 1 publication

(1 citation statement)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The use of temporary, percutaneous ventricular assist devices (pVADs) in the treatment and stabilization of patients with cardiogenic shock has steadily increased. 1–5 Most commonly, lower-body arterial access (LBAA) is attained through the femoral vessels for extracorporeal membrane oxygenation (ECMO) support or left ventricular support with an Impella CP (Abiomed, Danvers, MA, USA). 6–9 Because of the ease and expedience of access, interventional cardiologists use an LBAA to stabilize the patient; although the use of ECMO does not preclude ambulation at experienced centers, patients supported by an Impella CP through LBAA remain bedridden.…”

Section: Introductionmentioning

confidence: 99%

Transaortic Placement of Percutaneous Mechanical Support Device via Partial Sternotomy: Feasible Option for Unsuitable Axillary Artery Access

Armas

Shirafkan

Akay

et al. 2022

Innovations�(Phila)

View full text Add to dashboard Cite

Acute decompensated refractory cardiogenic shock is an emergency in which the prompt instauration of mechanical circulatory support improves outcomes. The typical, initial approach for device delivery is via femoral vessels due to easy access and safety. If longer support is needed, the femoral access will severely impair the patient’s mobility and can also limit the amount of support given as the new-generation devices are too large for direct arterial insertion. Upper-body arterial conduits (UBACs) are used for the delivery of larger, percutaneous ventricular assist devices (pVADs). The Impella 5.5 (Abiomed, Danvers, MA, USA) is a pVAD that can be deployed through a UBAC by either axillary/subclavian access or a transaortic approach. The latter approach is typically used in cases of postcardiotomy shock, in which the ascending aorta is already exposed through a full sternotomy. However, in some cases, the axillary artery is not suitable due to size (<6 mm in diameter), and a smaller pVAD is delivered into the heart. To avoid providing suboptimal support, we present an alternative, minimally invasive approach in which the larger device is delivered through the ascending aorta. This article summarizes the details of this approach through a mini upper partial sternotomy and reviews the relevant technical considerations.

show abstract