title: A bailout approach: Transaxillary Impella implantation in toxic cardiomyopathy.
abstract: The femoral artery has been the traditional approach for implantation of the Impella left ventricular assist device. We describe the case of a young man with toxic (cocaine-related) cardiomyopathy, severe left ventricular dysfunction, and moderate mitral insufficiency who received a transfemoral Impella left ventricular assist device that was relocated to the right axillary artery due to uncontrolled femoral access bleeding. The patient immediately stabilized post-implantation and was successfully bridged to a full recovery 6 days later.
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada.
authors.forename: Feras
authors.initials: F
authors.lastname: Khaliel
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Moss
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Demers
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada denis.bouchard@icm-mhi.org.
authors.forename: Denis
authors.initials: D
authors.lastname: Bouchard
mesh_terms: D000328:Adult; D001366:Axillary Artery; D009202:Cardiomyopathies / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D066126:Cardiotoxicity; D019970:Cocaine-Related Disorders / Q000150:complications*; D017548:Echocardiography, Transesophageal; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods*; D011677:Punctures; D020127:Recovery of Function; D012770:Shock, Cardiogenic / Q000139:chemically induced / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: Axillary artery; cardiogenic; cardiomyopathies; cocaine-related disorders; heart-assist devices; shock