Author + information
- James McCabe1,
- Amir Khaki2,
- William Nicholson3,
- Nimrod Blank2,
- J. Aaron Grantham4,
- William Lombardi5 and
- Rajiv Tayal6
- 1University of Washington, Seattle, Washington, United States
- 2Detroit Medical Center, Detroit, Michigan, United States
- 3York Hospital - Wellspan Health, York, Pennsylvania, United States
- 4University of Missouri Kansas City and Mid America Heart Institute, Kansas City, Missouri, United States
- 5University of Washington Medical Center, Seattle, Washington, United States
- 6Newark Beth Israel Medical Center, Newark, New Jersey, United States
The Impella© microaxial pump devices have been used widely in recent years. However, their utilization can be limited by inhospitable iliofemoral vessels or a desire to mobilize patients who require support for a prolonged period. Surgical exposure of the axillary artery is an alternative solution, but fully percutaneous axillary access may also be feasible.
The Axillary access Registry to Monitor Safety [ARMS] is a prospective multicenter registry of percutaneous upper extremity access for mechanical circulatory support devices to evaluate the procedural and short term safety of such an approach. All outcomes are site reported via dedicated collection form.
Fifty one cases were performed between 1/2015 and 6/2017 including 42 Impella CP’s, 6 Impella 2.5’s, and 3 Impella 5.0’s. The intended device was successfully implanted in 98% of cases. The mean patient age was 58 years (range 20-85) and 71% were male. The indications for support were varied; elective high-risk PCI (25%) was most common, followed by non-ischemic cardiogenic shock (22%). Implants were evenly split between right and left arms with the majority (86%) implanted in the first segment of the axillary (infraclavicular chest) and the remainder implanted infra-pectoral. Implant and in-hospital outcomes are listed in Table 1. The median implant duration was 2.5 days (IQR 0-6 days, range 0-21 days). Thirty six cases were explanted, 15 patients died prior. Survival to hospital discharge was 67% overall.
|Access Related Complications (n=51)|
|Bleeding and Hematoma||3 (6%)|
|Stroke or TIA||0 (0%)|
|Ischemic Hand||0 (0%)|
|Plexopathy or nerve injury||0 (0%)|
|Vascular injury||1 (2%)|
|Any unplanned surgery||0 (0%)|
|Closure Method (n=36)||Closure Device 30 (83%), stent graft 6 (17%), surgical 0 (0%)|
|Post-explant transition (n=36)||Recovery 28 (78%), durable device/heart transplant 8 (22%)|
Percutaneous implantation and explantation of the Impella© family of devices is feasible. Our preliminary data suggest vascular complication rates that compare favorably to published rates utilizing standard femoral access. There were no neurologic or ischemic sequelae to the subtended hand.
CORONARY: Hemodynamic Support and Cardiogenic Shock