Safety and Feasibility of Transcaval Access for the Delivery of Impella Microaxial Flow Pump

TL;DR

This study shows that using a transcaval approach to place a heart pump is safe and effective for patients with severe heart failure.

Contribution

Demonstrates the safety and feasibility of transcaval access for Impella pumps in cardiogenic shock patients.

Findings

Transcaval access and device placement were successful in all 72 patients.

In-hospital survival was 44.4% with no major vascular complications.

Bleeding events and acute kidney injury were observed in a minority of patients.

Abstract

Transcaval access (TCA) may enable percutaneous mechanical circulatory support (MCS) with reduced risk of vascular complications in cardiogenic shock patients needing mechanical support.

This single-center retrospective study included patients who underwent TCA placement of an Impella 5.0 (Abiomed) from June 2015 to March 2023. Data on demographic characteristics, clinical, procedural variables, and in-hospital outcomes were collected.

Seventy-two patients (mean age, 58.2 years; 66.7% men) were included. Twenty-eight patients had nonischemic cardiomyopathy and 43 had ischemic cardiomyopathy, with a baseline left ventricular ejection fraction of 23.5% ± 14.2%. Most patients (90.3%) were in categories C to E of the Society for Cardiovascular Angiography & Interventions (SCAI) classification for cardiogenic shock. TCA and MCS delivery were successful in all cases. Forty-two patients survived to explant device and TCA sheath, with successful explant in 36 using nitinol occluders; 7 needed a covered stent due to underlying right ventricular dysfunction to avoid right ventricular failure. Overall, in-hospital survival was 44.4%, with 43.8% in the nonischemic group and 56.2% in the ischemic group. Bleeding Academic Research Consortium (BARC) bleeding >1 occurred in 13.9%. No vascular complications from the access site were observed. During hospitalization, 16.7% had ventricular tachycardia/ventricular fibrillation and 5.6% had pulseless electrical activity postimplantation. Acute kidney injury requiring hemodialysis occurred in 15.3%, and 4.2% had a stroke. The average length of stay was 19.9 days (IQR, 3-28.25).

Transcaval access for Impella 5.0 is safe and feasible in experienced hands for patients needing advanced MCS due to inadequate peripheral arterial access or insufficient support from conventional devices.

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