Optimization of Impella 5.0 implantation using mini-sternotomy approach in postmyocardial infarction cardiogenic shock

A bailout approach: Transaxillary Impella implantation in toxic cardiomyopathy

The femoral artery has been the traditional approach for implantation of the Impella left ventricular assist device. We describe the case of a young man with toxic (cocaine-related) cardiomyopathy, severe left ventricular dysfunction, and moderate mitral insufficiency who received a transfemoral Impella left ventricular assist device that was relocated to the right axillary artery due to uncontrolled femoral access bleeding. The patient immediately stabilized post-implantation and was successfully bridged to a full recovery 6 days later.

Impella 5.0 microaxial pump as a right ventricular assist device after surgical treatment of posterior post-infarction ventricular septal defect

The Impella Recover LP 5.0 is an aortic transvalvular microaxial pump designed to unload the left ventricle and to ensure a systemic flow in severe left ventricular dysfunction. We propose a new suggestion for the Impella 5.0 as a temporary right ventricular assist device after the surgical treatment of a posterior post-infarction ventricular septal defect.

Future Directions for Percutaneous Mechanical Circulatory Support Devices

Outcomes of patients in cardiogenic shock remain high, but the development of novel percutaneous mechanical circulatory support devices offers additional therapeutic options. Hand in hand with innovations in device technology, however, must also come development of integrated circulatory support networks focusing on rapid assessment of patients, multidisciplinary discussion, and timely therapeutic intervention. This article summarizes some of the recent developments in device technology; potential procedures for patient risk stratification, device selection, and response to therapy; management of vascular access to reduce insertion point complications; and some of the expanding potential roles of percutaneous mechanical circulatory support devices.

Impella 5.0 support in severe peripheral vascular disease via iliac artery approach

Impella has been reported to provide hemodynamic support in cardiogenic shock patients, acute myocardial infarction, and high-risk percutaneous coronary intervention. We are reporting the case of using iliac artery cut down for Impella 5.0 in a high-risk percutaneous coronary intervention for a patient with severe ischemic cardiomyopathy who was not a surgical candidate.