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Surgical transaxillary placement of the Impella 5.0 ventricular assist device
Author(s) -
Bertoglio Luca,
Katsarou Maria,
Scandroglio Mara,
Bertoldi Letizia,
Chiesa Roberto,
Pappalardo Federico
Publication year - 2019
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.13978
Subject(s) - medicine , impella , surgery , hematoma , axillary artery , clinical endpoint , extracorporeal membrane oxygenation , ventricular assist device , heart failure , cardiology , randomized controlled trial
Abstract Objective The aim of this study is to evaluate the open transaxillary placement of the Impella 5.0 with a modified surgical technique. Methods From January to July 2018, nine patients (eight males; mean age 60 years) underwent surgical transaxillary Impella 5.0 (Abiomed Inc., Danvers, MA) implantation. Patient and periprocedural data were recorded in a prospectively maintained institutional database. The primary endpoint was technical success. The secondary endpoints were: neurological complications (peripheral or central), bleeding, and wound infection, duration of Impella support, and device failure requiring device replacement. Results Assisted technical success was 100%. The right axillary artery was used in 8/9 cases. Three patients (all on extracorporeal membrane oxygenation) suffered from access site bleeding which required surgical reintervention. One patient suffered from peripheral neurological dysfunction which recovered in 1 month and one patient had a local hematoma which was managed conservatively. The median length of treatment was 16 days (range 8‐35). Five patients had myocardial recovery and the Impella could be explanted; the remaining were transitioned to a durable left ventricular assist device with an uneventful postoperative course. Hospital mortality was 33%. Conclusions Open Impella 5.0 device implantation through the axillary artery is safe and effective; technical success was 100% and low rates of major complications are reported.