PMID- 33741787
OWN - NLM
STAT- MEDLINE
DCOM- 20220201
LR  - 20230821
IS  - 1538-943X (Electronic)
IS  - 1058-2916 (Linking)
VI  - 68
IP  - 1
DP  - 2022 Jan 1
TI  - Transcarotid Approach to Placement of an Impella 5.0.
PG  - e12-e15
LID - 10.1097/MAT.0000000000001407 [doi]
AB  - Microaxial left ventricular assist devices (mLVADs) have traditionally been 
      placed through a transfemoral or transaxillary arterial approach. Transfemoral 
      access is restrictive, significantly limiting postoperative patient ambulation. 
      Transaxillary placement is preferred but not feasible in a subset of patients due 
      to small arterial diameter or tight angulation of the thoracic outlet. 
      Transcarotid delivery has been utilized for other cardiovascular device 
      deployment with good success; however, this approach has not been described for 
      mLVAD support. We present a case series of transcarotid placement of mLVADs in 
      cases where a transaxillary and transfemoral approach was not feasible. From May 
      2017 to April 2019, six patients in cardiogenic shock required mLVAD support 
      achieved via a transcarotid approach. Technical success was achieved in all 
      patients. One patient was directly weaned from mLVAD support and two patients 
      died on mLVAD support. Escalation to venoarterial extracorporeal membrane 
      oxygenation (VA-ECMO) was required for three patients, two of whom subsequently 
      died. There were no bleeding or valvular complications related to device 
      placement, and no obvious or known neurologic complications related to mLVAD 
      support. Transcarotid placement of mLVADs expands the utility of these devices as 
      an alternative to traditional support strategies or prohibitive arterial anatomy; 
      however, further study is needed to determine its efficacy.
CI  - Copyright (c) ASAIO 2021.
FAU - Ramamurthi, Adhitya
AU  - Ramamurthi A
AUID- ORCID: 0000-0001-8937-3310
AD  - From the Department of Surgery, Medical College of Wisconsin, Milwaukee, 
      Wisconsin.
FAU - Cain, Michael T
AU  - Cain MT
AUID- ORCID: 0000-0003-4029-2557
AD  - From the Department of Surgery, Medical College of Wisconsin, Milwaukee, 
      Wisconsin.
FAU - Smith, Nathan
AU  - Smith N
AUID- ORCID: 0000-0002-5443-9962
AD  - Department of Surgery, Division of Cardiothoracic Surgery, Medical College of 
      Wisconsin, Milwaukee, Wisconsin.
FAU - Espinal, Angelia
AU  - Espinal A
AD  - Department of Surgery, Division of Cardiothoracic Surgery, Medical College of 
      Wisconsin, Milwaukee, Wisconsin.
FAU - Joyce, David L
AU  - Joyce DL
AD  - Department of Surgery, Division of Cardiothoracic Surgery, Medical College of 
      Wisconsin, Milwaukee, Wisconsin.
FAU - Mohammed, Asim
AU  - Mohammed A
AD  - Lutheran Health Network, Advanced Heart Failure, Fort Wayne, Indiana.
FAU - Joyce, Lyle D
AU  - Joyce LD
AD  - Department of Surgery, Division of Cardiothoracic Surgery, Medical College of 
      Wisconsin, Milwaukee, Wisconsin.
FAU - Durham, Lucian A
AU  - Durham LA
AD  - Department of Surgery, Division of Cardiothoracic Surgery, Medical College of 
      Wisconsin, Milwaukee, Wisconsin.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - ASAIO J
JT  - ASAIO journal (American Society for Artificial Internal Organs : 1992)
JID - 9204109
SB  - IM
MH  - *Extracorporeal Membrane Oxygenation/adverse effects
MH  - *Heart-Assist Devices/adverse effects
MH  - Humans
MH  - Postoperative Period
MH  - Retrospective Studies
MH  - Shock, Cardiogenic/etiology/surgery
COIS- Disclosure: Dr. Joyce serves as a consultant for Abiomed. The other authors have 
      no conflicts of interest to report.
EDAT- 2021/03/21 06:00
MHDA- 2022/02/02 06:00
CRDT- 2021/03/20 06:07
PHST- 2021/03/21 06:00 [pubmed]
PHST- 2022/02/02 06:00 [medline]
PHST- 2021/03/20 06:07 [entrez]
AID - 00002480-202201000-00023 [pii]
AID - 10.1097/MAT.0000000000001407 [doi]
PST - ppublish
SO  - ASAIO J. 2022 Jan 1;68(1):e12-e15. doi: 10.1097/MAT.0000000000001407.