title: Thirty-five day Impella 5.0 support via right axillary side graft cannulation for acute cardiogenic shock.
abstract: We describe the use of an Impella 5.0 for mechanical support in acute cardiogenic shock after an acute myocardial infarction. A 61-year-old man with a history of severe coronary artery disease who underwent coronary artery bypass grafting with ischemic cardiomyopathy presented with cardiogenic shock after an ST-elevation myocardial infarction. An Impella Recover LP 5.0 (Abiomed, Danvers, MA USA) was inserted via a right axillary side graft, using transesophageal echocardiographic and fluoroscopic guidance. The patient remained in the intensive care unit, where he required a tracheostomy to be weaned off the ventilator. He required renal replacement therapy with subsequent complete recovery. His Impella support was weaned, and on postoperative day 35, the device was removed. The patient developed axillary thrombosis the morning after removal, requiring thrombectomy. Discharge echocardiogram showed mild left ventricular enlargement with global hypokinesis and left ventricular ejection fraction of 25%. The Impella 5.0 device can safely and effectively be used in the long-term support of cardiogenic shock.
authors.affiliation: From the *Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC USA; and †Division of Cardiothoracic Surgery, Department of Surgery, and ‡Division of Cardiology, Department of Medicine, Washington University School of Medicine, St Louis, MO USA.
authors.forename: Mario A
authors.initials: MA
authors.lastname: Castillo-Sang
authors.forename: Sunil M
authors.initials: SM
authors.lastname: Prasad
authors.forename: Jasvindar
authors.initials: J
authors.lastname: Singh
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Ewald
authors.forename: Scott C
authors.initials: SC
authors.lastname: Silvestry
mesh_terms: D000208:Acute Disease; D001366:Axillary Artery; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D016638:Critical Illness; D020878:Device Removal / Q000009:adverse effects; D006353:Heart-Assist Devices; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D011379:Prognosis; D012121:Respiration, Artificial; D018570:Risk Assessment; D012770:Shock, Cardiogenic / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods; D013997:Time Factors; D014139:Tracheostomy / Q000379:methods; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery