# Surgical Technique for Stroke Prevention During Ventricular Assist Device Removal

## TL;DR

A surgical technique is described to prevent strokes when removing a heart support device called Impella 5.5, showing promising results in three patients.

## Contribution

The paper introduces a novel surgical technique combining Trendelenburg positioning, carotid occlusion, and thrombectomy to reduce stroke risk during Impella 5.5 removal.

## Key findings

- Three patients underwent the technique with no postoperative strokes or neurological deficits.
- The method was feasible and safe for high-risk surgical candidates.
- Device removal occurred 13 to 43 days after implantation without complications.

## Abstract

Mechanical circulatory support with the Impella 5.5 is increasingly used as a bridge to heart transplantation or durable left ventricular assist device in patients with chronic heart failure. However, thrombosis and stroke remain significant concerns upon Impella 5.5 device removal. To mitigate this risk, one technique involves placing the patient in the Trendelenburg position, temporary carotid occlusion, and Fogarty thrombectomy during device explantation. We retrospectively report outcomes from 3 patients (mean age 45; 2 male) with chronic end-stage heart failure who underwent this technique between September 2022 and June 2023. Impella implantation was via axillary access as a bridge to heart transplant (n = 2) or durable left ventricular assist device (n = 1), with device removal 13 to 43 days later. All patients remained neurologically intact postoperatively, with no strokes or deficits. This case series supports the feasibility and safety of this technique in mitigating stroke risk during Impella 5.5 removal in high-risk surgical candidates.