Background
Impella 5.0 and 5.5 (summarized as Impella 5+) are microaxial, catheter-based left
ventricular assist devices (LVAD) that are implanted via a vascular graft sutured
to the axillary artery and provide blood flow of up to 5.5 liter/min. This study aims
to investigate the incidence of long-term complications following circulatory support
with Impella 5+.
Methods
A single-center retrospective analysis of 203 consecutive adult patients treated between
January 2017 and September 2021 with a surgically implanted Impella 5.0 or 5.5 via
a vascular graft sutured to the axillary artery.
Results
The median Impella support duration was 8 days. Of 203 patients, 78 (38.4%) died while
on temporary mechanical circulatory support. Fifty-five (27.1%) were successfully
weaned from Impella 5+ and 70 (34.5%) were bridged to a durable LVAD with a median
follow-up time of 232 (IQR 68.5, 597) days after Impella 5+ explantation. In 119 of
these patients, the Impella was explanted and the vascular graft was shortened, ligated,
and pushed under the pectoralis muscle; in 6 patients early graft infection prompted
complete graft removal during explantation. In addition, 13 patients (10.9%) developed
a late-onset graft infection after a median of 86 days, requiring complete (n = 10) or partial (n = 2) explantation of the retained graft. In 1 patient, the graft infection was successfully
treated by conservative therapy. Our analysis identified no specific risk factors
for graft infections. Of the 203 patients, 5 (2.5%) developed a brachial plexus injury
resulting in neurological dysfunction.
Conclusions
In 10.9% of patients, retaining the vascular graft was complicated by a late graft
infection. Complete explantation of the graft prosthesis may decrease the infection
rate, but may in turn increase the risk of brachial plexus injury. On the other hand,
this method offers the possibility of bedside explantation.
KEYWORDS
Abbreviations:
BPI (brachial plexus injury), dLVAD (durable left ventricular assist device), IQR (interquartile range), LVAD (left ventricular assist device), PGI (prosthetic graft infection), SD (standard deviation), tMCS (temporary mechanical circulatory support), va-ECLS (veno-arterial extracorporeal life support.)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 26, 2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 International Society for Heart and Lung Transplantation. All rights reserved.
