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Cardiovasc Revasc Med. 2019 Sep;20(9):827-828. doi: 10.1016/j.carrev.2018.12.006. Epub 2018 Dec 19.

Safe Exchange of a Transfemoral Impella Pump.

Author information

1
Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany. Electronic address: tongers.joern@mh-hannover.de.
2
Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.

Abstract

Mechanical circulatory support with the Impella pump is established in many centers treating patients with cardiogenic shock. While Impella pumps usually run very stable, it may still be possible that one needs to remove the pump for using the same vascular access for different reasons. Unfortunately, until now it had been nearly impossible to remove the pump while preserving arterial access without severe bleeding. Here we describe a prototypical approach of exchanging an Impella pump in a 47-year-old female supported with veno-arterial ECMO for cardiogenic shock from myocarditis. The dysfunctional Impella pump was safely removed and replaced by a new one through the same arterial access site. Continuation of active LV unloading resolved pulmonary edema, and the patient was finally bridged to ventricular assist device surgery with favorable outcome. In general, the described approach is applicable for virtually all large-bore devices with arterial access.

KEYWORDS:

Cardiogenic shock; Impella; Left ventricular assist device; Mechanical circulatory support

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