A Post-closure Technique Using a Single Perclose Device in the Removal of a Transfemoral Impella Catheter

Abstract

A transfemoral Impella can substantially support patients with cardiogenic shock, and surgical closure has conventionally been used for the removal of large-bore catheters. However, while percutaneous closure is a prompt and minimally invasive technique, single Perclose post-closure outcomes remain to be evaluated. The present study evaluated the safety and efficacy of single Perclose post-closure in the removal of transfemoral Impella catheters. Methods: Of 37 patients supported by an Impella device, 25 patients (68%) were excluded due to a transsubclavian approach, an inability to wean, or primary surgical closure. We reviewed 12 patients (32%) receiving the single Perclose post-closure method. For percutaneous closure, we inserted a 0.035-inch guidewire through the side port of the Impella device and extracted the device while retaining the guidewire. Single Perclose was deployed with an additional maneuver as backup, such as second Perclose or surgical closure. The outcomes were defined according to the Valve Academic Research Consortium-2 criteria. Results: All patients had received the Impella CP due to cardiogenic shock. All patients received single/dual antiplatelets without oral anticoagulants. Percutaneous closure was successful in 11 patients (92%); the remaining patient was converted to surgical closure. The mean (range) procedural time was 8.0 (5.8-9.0) minutes. Major bleeding and vascular complications were observed only in the patient with surgical conversion (8.3%). No closure-site infection or closure-related limb ischemia was observed. All patients were discharged alive after the removal of the Impella device. Conclusion: Single Perclose post-closure is a promising closure method for removing a transfemoral Impella, but further investigations are needed.