title: Using the Impella 5.0 with a right axillary artery approach as bridge to long-term mechanical circulatory assistance.
abstract: OBJECTIVE
  Impella 5.0 is a short-term left ventricle assist device (LVAD), inserted retrograde into the left ventricle across the aortic valve through a surgical peripheral access. Impella has been utilized for various indications but in the setting of bridge-to-bridge application there are limited reports.
  
  
  METHODS
  We performed a retrospective observational analysis of Impella utilization at our institution as bridge to long-term LVADs. The primary end-point was survival during Impella support.
  
  
  RESULTS
  Between December 2010 and February 2012, we implanted 20 Impella in patients with cardiogenic shock and, among these, 5 were implanted as bridge to long-term LVADs. In this latter group, mean age at the time of implantation was 44 ± 15.6 (range 27-68) years and there was a prevalence of males (80%). Etiology of cardiogenic shock was: decompensated anthracycline-induced cardiomyopathy (n = 1), myocardial infarction (n = 4). There was no major bleeding requiring surgical revision or infectious complications at the right axillary access. One patient required Impella replacement due to a pump stop. After a mean period of 14.2 ± 9.0 (range 6-27) days of Impella support, patients were switched to a long-term LVAD (Jarvik 2000, n = 2; HeartMate II, n = 3). One patient died 70 days after implantation of the long-term LVAD due to multi-organ failure, while the remaining patients are still alive after a mean period of follow-up of 108.6 ± 66.2 (range 19-191) days.
  
  
  CONCLUSIONS
  Our experience shows that an Impella 5.0 implanted through the right axillary artery approach is a valid option as bridge to long-term LVADs.
authors.affiliation: Division of Cardiac Surgery, Pitié-Salpêtrière Hospital, Pierre and Marie Curie University, Paris 6, Paris - France and Cardiovascular Surgery Unit, University of Verona Medical School, Verona - Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Pozzi
authors.forename: Astrid
authors.initials: A
authors.lastname: Quessard
authors.forename: Anthony
authors.initials: A
authors.lastname: Nguyen
authors.forename: Ciro
authors.initials: C
authors.lastname: Mastroianni
authors.forename: Michaela
authors.initials: M
authors.lastname: Niculescu
authors.forename: Alain
authors.initials: A
authors.lastname: Pavie
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
mesh_terms: D000328:Adult; D000368:Aged; D001366:Axillary Artery / Q000601:surgery*; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome