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Thirty-Five Day Impella 5.0 Support via Right Axillary Side Graft Cannulation for Acute Cardiogenic Shock

Castillo-Sang, Mario A. MD*; Prasad, Sunil M. MD; Singh, Jasvindar MD; Ewald, Gregory A. MD; Silvestry, Scott C. MD

Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery: July/August 2013 - Volume 8 - Issue 4 - p 307–309
doi: 10.1097/IMI.0000000000000009
Case Reports

Abstract: We describe the use of an Impella 5.0 for mechanical support in acute cardiogenic shock after an acute myocardial infarction. A 61-year-old man with a history of severe coronary artery disease who underwent coronary artery bypass grafting with ischemic cardiomyopathy presented with cardiogenic shock after an ST-elevation myocardial infarction. An Impella Recover LP 5.0 (Abiomed, Danvers, MA USA) was inserted via a right axillary side graft, using transesophageal echocardiographic and fluoroscopic guidance. The patient remained in the intensive care unit, where he required a tracheostomy to be weaned off the ventilator. He required renal replacement therapy with subsequent complete recovery. His Impella support was weaned, and on postoperative day 35, the device was removed. The patient developed axillary thrombosis the morning after removal, requiring thrombectomy. Discharge echocardiogram showed mild left ventricular enlargement with global hypokinesis and left ventricular ejection fraction of 25%. The Impella 5.0 device can safely and effectively be used in the long-term support of cardiogenic shock.

From the *Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC USA; and †Division of Cardiothoracic Surgery, Department of Surgery, and ‡Division of Cardiology, Department of Medicine, Washington University School of Medicine, St Louis, MO USA.

Accepted for publication June 24, 2013.

Disclosure: The authors declare no conflicts of interest.

Address correspondence and reprint requests to Scott C. Silvestry, MD, Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, CB8234, 660 S. Euclid Ave, St Louis, MO 63110 USA. E-mail: silvestrys@wustl.edu.

©2013 by the International Society for Minimally Invasive Cardiothoracic Surgery