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Surgical transaxillary placement of the Impella 5.0 ventricular assist device.

Authors
  • Bertoglio, Luca1
  • Katsarou, Maria1
  • Scandroglio, Mara2
  • Bertoldi, Letizia3
  • Chiesa, Roberto1
  • Pappalardo, Federico2, 3
  • 1 Division of Vascular Surgery, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy. , (Italy)
  • 2 Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. , (Italy)
  • 3 Cardiac Intensive Care, Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Scientific Institute, Milan, Italy. , (Italy)
Type
Published Article
Journal
Journal of Cardiac Surgery
Publisher
Wiley (Blackwell Publishing)
Publication Date
Feb 01, 2019
Volume
34
Issue
2
Pages
92–98
Identifiers
DOI: 10.1111/jocs.13978
PMID: 30625252
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The aim of this study is to evaluate the open transaxillary placement of the Impella 5.0 with a modified surgical technique. 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. 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%. 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. © 2019 Wiley Periodicals, Inc.

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