Bridge-to-Decision LVAD Support Using the Impella 5.0 Via a Right Subclavian Artery Approach

Bansal, A., Bhama, J. K., Patel, H., Desai, S., Mandras, S., Ahmad, U., Laudun, S., Patel, R., Reily, J., Ventura, H. and Parrino, E. (2013). Bridge-to-Decision LVAD Support Using the Impella 5.0 Via a Right Subclavian Artery Approach. In: 33rd Annual Meeting and Scientific Sessions of the International-Society-for-Heart-and-Lung-Transplantation, Montreal Canada, (S281-S281). Apr 24-27, 2013. doi:10.1016/j.healun.2013.01.740

Author Bansal, A.
Bhama, J. K.
Patel, H.
Desai, S.
Mandras, S.
Ahmad, U.
Laudun, S.
Patel, R.
Reily, J.
Ventura, H.
Parrino, E.
Title of paper Bridge-to-Decision LVAD Support Using the Impella 5.0 Via a Right Subclavian Artery Approach
Conference name 33rd Annual Meeting and Scientific Sessions of the International-Society-for-Heart-and-Lung-Transplantation
Conference location Montreal Canada
Conference dates Apr 24-27, 2013
Journal name Journal of Heart and Lung Transplantation   Check publisher's open access policy
Place of Publication Philadelphia, United States
Publisher Elsevier
Publication Year 2013
Year available 2013
Sub-type Published abstract
DOI 10.1016/j.healun.2013.01.740
Open Access Status
ISSN 1053-2498
Volume 32
Issue 4
Start page S281
End page S281
Total pages 1
Language eng
Formatted Abstract/Summary
Despite advances in heart failure therapy, acute decompensated heart failure portends a dismal prognosis. Traditional bridge-to-decision (BTD) mechanical circulatory support options include IABP, ECMO and LVAD. We report on our recent experience with the Impella 5.0 implanted via the right subclavian artery (RSA) for temporary BTD support.

Methods and Materials
A single-center retrospective review was performed of 15 patients with acute decompensated heart failure who received the Impella 5.0 via the RSA from 6/2011-9/2012. The device was implanted via a cutdown through an 8mm vascular graft sewn to the RSA and coupled to a 24-F GORE Dry-Seal sheath. The device was positioned with fluoroscopy/TEE. Students t-test was used to determine statistical differences in pre-and post- implant parameters.

Perioperative demographics are listed in table 1. At implantation, all patients were mechanically ventilated on inotropes with persistent cardiogenic shock and 9 (60%) were on IABP support. Post-implantation, 12 (80%) were extubated and all nine tolerated discontinuation of IABP support. There was a significant reduction in the MELD score pre- vs. post-implantation (20 vs. 15, p=0.02), suggesting improvement in end-organ function. The end-point of BTD support included recovery in 3 (20%), heart transplantation in 2 (13%), and permanent LVAD in 4 (27%) all of whom are currently awaiting transplant. Death occurred in 6 (40%) due to multi-system organ failure, infection, or family withdrawal of care.

The RSA approach for Impella 5.0 implantation is an acceptable BTD strategy and results in improved end-organ function allowing bridge to more durable therapies. Significant advantages to this approach include better left ventricular decompression, lower anti-coagulation need and the potential for ambulation and physical therapy.
Q-Index Code EX
Q-Index Status Provisional Code
Institutional Status Non-UQ

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Collection: School of Medicine Publications
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