The Double Barrel Impella Exchange: A Reliable Method for Uninterrupted Mechanical Circulatory Support.
J Heart Lung Transplant
; 2024 Jul 17.
Article
en En
| MEDLINE
| ID: mdl-39029638
ABSTRACT
Classic Impella exchange interrupts flow when the old device is pulled into the aorta before advancing the new device across the aortic valve, threatening circulatory collapse and loss of left ventricular access. In "double barrel," uninterrupted Impella exchange, the new device is placed into the ventricle alongside the old, where flow is first transitioned completely. Of thirty-one consecutive patients undergoing this procedure, none experienced intraoperative cardiac arrest and 96.8% (30/31) had no new aortic insufficiency. One vascular complication ensued following known preoperative iliac injury. One patient suffered nonembolic stroke; another had subarachnoid hemorrhage. Fifty-five percent (17/31) of patients survived, with 22.6% (7/31) recovering, 25.8% (8/31) undergoing transplant, and 6.5% (2/31) transitioning to durable LVAD. Impella-only survival (83.3%, 10/12) was significantly higher than Impella-ECMO survival (36.8%, 7/19) (OR 14.46, 95% CI 1.74-119.93, p=0.01). We conclude "double barrel" technique is reliable in device-dependent cardiogenic shock patients, offering significant advantage and minimal risk.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Idioma:
En
Revista:
J Heart Lung Transplant
Asunto de la revista:
CARDIOLOGIA
/
TRANSPLANTE
Año:
2024
Tipo del documento:
Article
País de afiliación:
Canadá