Bertoglio Luca, Katsarou Maria, Scandroglio Mara, Bertoldi Letizia, Chiesa Roberto, Pappalardo Federico
Division of Vascular Surgery, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy.
Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
J Card Surg. 2019 Feb;34(2):92-98. doi: 10.1111/jocs.13978. Epub 2019 Jan 9.
The aim of this study is to evaluate the open transaxillary placement of the Impella 5.0 with a modified surgical technique.
From January to July 2018, nine patients (eight males; mean age 60 years) underwent surgical transaxillary Impella 5.0 (Abiomed Inc., Danvers, MA) implantation. Patient and periprocedural data were recorded in a prospectively maintained institutional database. The primary endpoint was technical success. The secondary endpoints were: neurological complications (peripheral or central), bleeding, and wound infection, duration of Impella support, and device failure requiring device replacement.
Assisted technical success was 100%. The right axillary artery was used in 8/9 cases. Three patients (all on extracorporeal membrane oxygenation) suffered from access site bleeding which required surgical reintervention. One patient suffered from peripheral neurological dysfunction which recovered in 1 month and one patient had a local hematoma which was managed conservatively. The median length of treatment was 16 days (range 8-35). Five patients had myocardial recovery and the Impella could be explanted; the remaining were transitioned to a durable left ventricular assist device with an uneventful postoperative course. Hospital mortality was 33%.
Open Impella 5.0 device implantation through the axillary artery is safe and effective; technical success was 100% and low rates of major complications are reported.
本研究旨在评估采用改良手术技术经腋动脉开放植入Impella 5.0的情况。
2018年1月至7月，9例患者（8例男性；平均年龄60岁）接受了经腋动脉手术植入Impella 5.0（美国马萨诸塞州丹弗斯市Abiomed公司）。患者及围手术期数据记录于前瞻性维护的机构数据库中。主要终点为技术成功。次要终点包括：神经并发症（外周或中枢）、出血、伤口感染、Impella支持时间以及需要更换装置的装置故障。
辅助技术成功率为100%。9例中有8例使用右腋动脉。3例患者（均接受体外膜肺氧合）出现穿刺部位出血，需要再次手术干预。1例患者出现外周神经功能障碍，1个月后恢复，1例患者出现局部血肿，采取保守治疗。治疗的中位时长为16天（范围8 - 35天）。5例患者心肌恢复，可取出Impella；其余患者过渡到持久左心室辅助装置，术后过程平稳。医院死亡率为33%。
经腋动脉开放植入Impella 5.0装置安全有效；技术成功率为100%，且主要并发症发生率较低。
