Khan Shazli, Isath Ameesh, Gregory Vasiliki, Elgar Guy, Levine Avi, Haidry Syed A, Ahmad Hasan, Tavolacci Sooyun Caroline, Shimamura Junichi, Ohira Suguru
Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA.
New York Medical College, Valhalla, New York, USA.
Artif Organs. 2025 Jan;49(1):146-155. doi: 10.1111/aor.14861. Epub 2024 Sep 17.
The Impella 5.5® is commonly inserted via the axillary artery (AX) in patients with cardiogenic shock. The right AX has traditionally been preferred to avoid crossing the aortic arch, and a minimum diameter of 7 mm has been recommended to accommodate the device (21 Fr). There is limited data on choice of laterality of access and AX size required, both in terms of technicality of the procedure as well as outcomes.
We performed a single-center retrospective cohort analysis of patients who underwent Impella 5.5® implantation between December 2020 and February 2024 (N = 75). Data including demographics and outcomes were stratified both by diameter (small, <7 mm vs. normal, ≥7 mm) and laterality of access (right vs. left). Adverse events included stroke, limb ischemia, procedural bleeding or infection, and unplanned explant due to complications. Delivery time was defined as time from advancing the first wire to activation of the device.
AX approach was attempted in all (N = 74) but one requiring innominate access, with a technical success rate of 95.9% (N = 71/74). The mean age was 58.8 ± 13.3 years, with 81.1% males. The median delivery time was 7.0 (25th, 75th percentiles: 4.0, 11.5) min with a median support duration of 13 (7.7, 24) days. Ten patients (13.5%) had a small AX, with a mean diameter of 6.3 ± 0.5 mm and were more likely to be younger compared to the normal AX group. Fifty-nine patients (79.7%) had insertion via the right AX. Median delivery time was comparable across all groups (small, 5.4 [3.5, 10.9] vs. normal, 7 [4.0, 12.1] min, p = 0.59) and (right, 10.4 [5.3, 15.2] vs. left, 6 [3.7, 10.4] min, p = 0.35). There was no difference between the rates of stroke, ischemia, bleeding, or infection when comparing by size or laterality. Survival to discharge was 59.5%, with 21.1% mortality on support, all in patients with a normal AX diameter, but with no difference between right versus left.
In our study, laterality and a small diameter of AX access did not affect outcomes of Impella 5.5®, with a similar safety profile.
对于心源性休克患者，通常经腋动脉（AX）植入Impella 5.5®。传统上更倾向于选择右侧腋动脉以避免穿过主动脉弓，并且建议腋动脉最小直径为7毫米以容纳该装置（21F）。关于入路侧别选择和所需腋动脉尺寸的数据有限，无论是在手术技术方面还是在预后方面。
我们对2020年12月至2024年2月期间接受Impella 5.5®植入的患者进行了单中心回顾性队列分析（N = 75）。包括人口统计学和预后的数据按直径（小，<7毫米与正常，≥7毫米）和入路侧别（右侧与左侧）进行分层。不良事件包括中风、肢体缺血、手术出血或感染以及因并发症导致的计划外拔除装置。输送时间定义为从推进第一根导丝到激活装置的时间。
除1例需要无名动脉入路外，所有患者（N = 74）均尝试经腋动脉入路，技术成功率为95.9%（N = 71/74）。平均年龄为58.8±13.3岁，男性占81.1%。中位输送时间为7.0（第25、75百分位数：4.0，11.5）分钟，中位支持时间为13（7.7，24）天。10例患者（13.5%）的腋动脉较小，平均直径为6.3±0.5毫米，与正常腋动脉组相比，他们更可能较年轻。59例患者（79.7%）经右侧腋动脉植入。所有组的中位输送时间相当（小直径组，5.4 [3.5，10.9]分钟与正常直径组，7 [4.0，12.1]分钟，p = 0.59）以及（右侧组，10.4 [5.3，15.2]分钟与左侧组，6 [3.7，10.4]分钟，p = 0.35）。按尺寸或侧别比较时，中风、缺血、出血或感染的发生率没有差异。出院生存率为59.5%，在支持治疗期间死亡率为21.1%，所有死亡患者的腋动脉直径均正常，但右侧与左侧之间没有差异。
在我们的研究中，腋动脉入路的侧别和小直径并未影响Impella 5.5®的预后，安全性相似。
