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The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

Complications related to the access site after transaxillary implantation of a microaxial left ventricular assist device

  • Daniel Lewin
    Correspondence
    Reprint requests: Daniel Lewin Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Augustenburger Platz 1, 13353 Berlin, Germany.
    Affiliations
    Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
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  • Gaik Nersesian
    Affiliations
    Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany

    DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
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  • Pia Lanmüller
    Affiliations
    Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany

    DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
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  • Felix Schoenrath
    Affiliations
    Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany

    Department of Cardiovascular Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany

    DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
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  • Volkmar Falk
    Affiliations
    Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany

    Department of Cardiovascular Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany

    DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany

    Department of Health Sciences and Technology, Translational Cardiovascular Technologies, Institute of Translational Medicine, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
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  • Evgenij V. Potapov
    Affiliations
    Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany

    DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
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  • Sascha Ott
    Affiliations
    Department of Cardiac Anesthesiology and Intensive Care Medicine, German Heart Center Berlin, Germany

    DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany

    Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
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Published:December 26, 2022DOI:https://doi.org/10.1016/j.healun.2022.12.018

      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.)
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