Using the Impella 5.0 with a Right Axillary Artery Approach as Bridge to Long-Term Mechanical Circulatory Assistance

Pozzi, Matteo; Quessard, Astrid; Nguyen, Albert; Mastroianni, Ciro; Niculescu, M; Pavie, Alain; Leprince, Pascal

doi:10.5301/ijao.5000237

Cited by 22 publications

(20 citation statements)

References 15 publications

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“…11 This work adds to other evidence that Impella 5.0 is safe for stabilizing patients. 6,12 End-organ function improves and patients can be extubated and ambulated, making them better candidates for advanced therapies and avoiding ventilator-associated pneumonia and adult respiratory distress syndrome. 13,14 In addition, peripheral access avoids multiple chest entries, decreasing the chance of infections and other complications.…”

Section: Discussionmentioning

confidence: 99%

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Temporary Left Ventricular Assist Device Through an Axillary Access is a Promising Approach to Improve Outcomes in Refractory Cardiogenic Shock Patients

et al. 2015

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Cardiogenic shock (CS) causes significant morbidity and mortality and such patients can deteriorate rapidly. Temporary left ventricular assist devices (LVADs) are a promising approach to manage these patients. The following is a case series in which patients stabilized with a temporary LVAD for CS improvement were analyzed retrospectively. Between June 2011 and January 2014, 15 patients received temporary devices through an axillary approach (mean age: 53 ± 15, 93% male). Mean survival time was 317.8 ± 359.5 days (range: 6–936 days). During support there were no major bleeding events, infectious complications at the axillary access site, upper extremity edema, or emboli. The most of the patients recovered from CS (93%) were mobilized (67%) and were extubated (73%) while on temporary device support. Median times to extubation, intensive care unit discharge, and discontinuation of inotropic medications were: 1.63, 18, and 15 days, respectively. Four patients recovered to no device support and five received a long-term LVAD, all of whom remain alive. Therefore, implantation of a temporary LVAD through an axillary approach is a promising therapy for improving outcomes in patients needing mechanical circulatory support as a bridge to recovery or a definitive LVAD.

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Section: Discussionmentioning

confidence: 99%

“…The results from this study indicate that temporary LVAD implantation is a strategy for CS patients that could help decrease morbidity and mortality. 4–6 …”

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confidence: 99%

Temporary Left Ventricular Assist Device Through an Axillary Access is a Promising Approach to Improve Outcomes in Refractory Cardiogenic Shock Patients

et al. 2015

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“…A possible advantage of the axillary approach is the potential for long-term support. 52 The proximal 9 Fr catheter shaft houses the motor power leads and purge and pressure measurement lumens. The catheter's proximal end consists of a hub for attachment of a console cable and side arms for attachment of purge solution and pressure-measurement tubing.…”

Section: To Aorta-assist Devicesmentioning

confidence: 99%

2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care (Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology–Association Canadienne de Cardiologie d'intervention)∗

Rihal

Naidu

Givertz

et al. 2015

Journal of Cardiac Failure

246

319

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Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella(®); left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for right-sided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines.

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“…Previous investigators have reported favorable outcomes when using the Impella 5.0 for postcardiotomy shock, 4 acute cardiogenic shock, 5 acute rejection after heart transplantation, 6 and bridging to durable mechanical circulatory support. 7,8 Avoidance of repeat sternotomy for device exchange has important implications for the patient who is listed for heart transplantation. Prior cardiac surgery not only creates technical challenges during heart transplantation but is associated with increased morbidity and mortality rates after transplantation.…”

Section: Discussionmentioning

confidence: 99%

Microaxial Flow Left Ventricular Assist Device as a Bridge to Transplantation after LVAD Malfunction

Reich¹,

Shah²,

Azarbal³

et al. 2015

Texas Heart Institute Journal

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H eart failure remains the leading cause of death in the United States and worldwide, and the prevalence of heart failure in the U.S. continues to rise.1 For patients with refractory heart failure, cardiac function deteriorates despite maximal medical therapy, warranting consideration of mechanical circulatory support or heart transplantation. Because of the improvements in overall survival rates and in survival to transplantation imparted by newer, continuous-flow assist devices, the number of patients sustained by mechanical circulatory support as a bridge to transplantation is growing rapidly.2 Malfunction of continuous-flow devices is rare but remains a considerable challenge. Treatment options for patients with device malfunction include sternotomy or thoracotomy with left ventricular assist device (LVAD) exchange, extracorporeal membrane oxygenation, microaxial LVAD placement, intraaortic balloon counterpulsation, or inotropic support alone. The new-generation microaxial LVADs afford full support (generating flow rates of up to 5 L/min) and are inserted endovascularly, without a need to open the chest or to use cardiopulmonary bypass (CPB). Here, we describe the novel and successful use of the Impella ® 5.0 (Abiomed, Inc.; Danvers, Mass) as a bridge to transplantation in a patient with LVAD malfunction. Case ReportA 54-year-old-man with ischemic cardiomyopathy underwent placement of a HeartMate II ® LVAD (Thoratec Corporation; Pleasanton, Calif ) as a bridge to heart transplantation in December of 2010, 3 years before his presentation at our center. Because of his prolonged time on the transplant list, he was referred to our center for dual listing.While waiting for a suitable donor heart to become available, he developed frequent device malfunction due to malposition of the inflow cannula (Fig. 1). The LVAD malfunctions included intermittent low speeds and transient pump stops. Although poor cannula position is usually apparent early after implantation, our patient might have developed cannula malposition in a delayed manner because of left ventricular (LV) remodeling. We admitted him and listed him for heart transplantation as status 1A. Despite our reductions in pump speed, withholding of diuretics, aggressive fluid administration, and empiric heparinization for possible pump thrombosis, the LVAD alarms persisted. The frequency of alarms increased, and the device was no longer able to generate adequate flows. An echocardiogram showed an LV ejection fraction of 0.15 to 0.25 and no flow in the inflow cannula. The device was turned off to prevent emboli, and the patient was maintained on inotropic support.Despite maximal medical therapy, his cardiac function progressively deteriorated. We considered the risks and benefits of various mechanical circulatory support devices, including repeat sternotomy with LVAD exchange or total artificial heart implan-

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Using the Impella 5.0 with a Right Axillary Artery Approach as Bridge to Long-Term Mechanical Circulatory Assistance

Abstract: Our experience shows that an Impella 5.0 implanted through the right axillary artery approach is a valid option as bridge to long-term LVADs.

Cited by 22 publications

References 15 publications

Temporary Left Ventricular Assist Device Through an Axillary Access is a Promising Approach to Improve Outcomes in Refractory Cardiogenic Shock Patients

Temporary Left Ventricular Assist Device Through an Axillary Access is a Promising Approach to Improve Outcomes in Refractory Cardiogenic Shock Patients

Microaxial Flow Left Ventricular Assist Device as a Bridge to Transplantation after LVAD Malfunction

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