Temporary Left Ventricular Assist Device Through an Axillary Access is a Promising Approach to Improve Outcomes in Refractory Cardiogenic Shock Patients

Doersch, Karen; Tong, Carl W.; Góngora, Enrique; Konda, Subbareddy; Sareyyüpoğlu, Başar

doi:10.1097/mat.0000000000000222

Cited by 21 publications

(25 citation statements)

References 24 publications

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“…In total, 74 studies were screened for eligibility, and 22 studies met inclusion criteria and were included in the final analysis. 1,10,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]…”

Section: Search Resultsmentioning

confidence: 99%

Percutaneous large‐bore axillary access is a safe alternative to surgical approach: A systematic review

Southmayd

Hoque

Kaki

et al. 2020

Cathet Cardio Intervent

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Objectives: To systematically review relevant literature regarding cardiovascular outcomes of large-bore axillary arterial access via percutaneous and surgical approaches. Background: In patients with severe peripheral arterial disease (PAD) undergoing cardiac interventions, large-bore femoral access may be prohibitive. The axillary artery provides an alternative vascular access for transcatheter aortic valve replacement (TAVR) or mechanical circulatory support. There have been limited comparisons of percutaneous transaxillary (pTAX) approach with the more traditional surgical transaxillary (sTAX) approach. Methods: Pubmed and Medline databases were queried through January 2019 for studies describing pTAX or sTAX approaches with TAVR or Impella insertion. Primary outcomes were access-related mortality, 30-day mortality, stroke, major vascular complications, and major bleeding. Results: One hundred and fifty five studies were reviewed, with additional unpublished data from 1 institution. Twenty-two studies met the inclusion criteria. Patient data was heterogeneous, with 69% TAVR and 31% Impella use in the pTAX group, and 96% TAVR and 4% Impella use in the sTAX group. There was more cardiogenic shock in the pTAX group. When compared to surgical approach, the percutaneous approach had similar 30-day mortality for TAVR (5.6% vs 4.6%, OR nonsignificant) and Impella (43.4% vs 38.6%, OR non-significant), similar stroke rates (4.3% vs 4.2%, OR non-significant), similar major vascular complications (2.8% vs 2.3%, OR non-significant) and less major bleeding (2.7% vs 17.9%, OR significant). Conclusions: Data suggests large-bore pTAX access has similar 30-day mortality, stroke rates, and major vascular complications as sTAX access, with less major bleeding. Additional studies are needed to validate results.

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Section: Search Resultsmentioning

confidence: 99%

Percutaneous large‐bore axillary access is a safe alternative to surgical approach: A systematic review

Southmayd

Hoque

Kaki

et al. 2020

Cathet Cardio Intervent

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“…Multiple studies have shown that deployment of the Impella via the axillary or subclavian artery approach is safe and feasible. [3][4][5] No studies thus far have evaluated the benefits of early mobility in patients implanted with the Impella device on short-or long-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Of the left-sided support options, the Impella 2.5 LP and CP devices can be deployed percutaneously, while the Impella 5.0 device requires surgical vascular access through a conduit graft and is commonly deployed via the axillary artery. [2][3][4] Recent reports support the use of axillary intra-aortic balloon pump (IABP) for hemodynamic support; 5 however, no studies have reported on the clinical utility of axillary deployment of an Impella 5.0 pump. The purpose of our study was to evaluate mobility levels among patients with CS being treated with an axillary Impella 5.0 pump.…”

Section: Introductionmentioning

confidence: 99%

Maximum level of mobility with axillary deployment of the Impella 5.0 is associated with improved survival

et al. 2018

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Mobility is an important prognostic indicator for patients with cardiogenic shock. No studies have quantified peak mobility for patients with cardiogenic shock who are supported with the Impella 5.0 acute mechanical circulatory support device. The purpose of our study was to evaluate mobility levels among patients with cardiogenic shock being treated with an axillary Impella 5.0 pump. We retrospectively analyzed data from 19 patients receiving an Impella 5.0 device for cardiogenic shock at our institution from 2013 to 2016. We used the Johns Hopkins Highest Level of Mobility Scale to quantify maximum mobility level achieved during active Impella 5.0 support. Higher scores on a scale of 1-8 indicated more mobility. Activity Measure for Post Acute Care Scores were quantified for each patient to assess activity limitations, with a maximum score 24. The mean age of the total cohort was 60 ± 12 years, and the mean left ventricular ejection fraction was 16% ± 6%. In-hospital mortality was 47% (n = 9). Of the 19 Impella 5.0 implants, 10 survived, 6 died from withdrawal of care, and 3 died from worsening heart failure/cardiogenic shock. Similar rates of mobilization during the time of Impella implant were seen between groups. Compared to non-survivors, survivors achieved a higher maximum Johns Hopkins Highest Level of Mobility level, but similar Activity Measure for Post Acute Care scores. In conclusion, maximum mobility after Impella 5.0 implantation may be associated with improved survival. The clinical utility of exercise as a therapeutic intervention for patients requiring prolonged acute mechanical circulatory support requires further study.

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“…We conducted a retrospective review of 228 patients who had ventricular assist device‐Impella insertion from January 2014 to December 2015 at Detroit Medical Center, Michigan, USA. All patients had two sequentially placed 6 Fr Perclose‐ProGlide closure devices Preclosed (“Preclose” technique) at 90° angle prior to placing a 13‐14 Fr arterial sheath for Impella.…”

Section: Methodsmentioning

confidence: 99%

Pre‐close technique of percutaneous closure for delayed hemostasis of large‐bore femoral sheaths

Lata¹,

Kaki

Grines

et al. 2018

J Interven Cardiology

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Advancement of coronary interventions and portable hemodynamic device requires placement of large bore sheaths. Access for large caliber sheaths, its placement, maintenance, and hemostasis is very challenging and one of the key ailments for successful procedures. Traditional hemostasis method is manual compression, which is unattractive due to its own limitations and subsequent complications. Single closure device for sheath size larger than 8 French (Fr) is not available. We performed retrospective analysis of large cohort of patients with 13, 14 Fr sheaths (Impella device [ABIOMED]) percutaneous closure with the use of two Perclose devices. Two perclose devices were placed in a "Preclose" fashion and hemostasis was obtained few days later once hemodynamic support was weaned off by deployment of perclose sutures.

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Temporary Left Ventricular Assist Device Through an Axillary Access is a Promising Approach to Improve Outcomes in Refractory Cardiogenic Shock Patients

Cited by 21 publications

References 24 publications

Percutaneous large‐bore axillary access is a safe alternative to surgical approach: A systematic review

Percutaneous large‐bore axillary access is a safe alternative to surgical approach: A systematic review

Maximum level of mobility with axillary deployment of the Impella 5.0 is associated with improved survival

Pre‐close technique of percutaneous closure for delayed hemostasis of large‐bore femoral sheaths

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