Absi Mohammed, Gienapp Andrew J, Buyukgoz Cihangir, Sathanandam Shyam, Boston Umar
Heart Institute, Le Bonheur Children's Hospital, Memphis, TN, USA.
Pediatric Cardiology, University of Tennessee Health Science Center, Memphis, TN, USA.
World J Pediatr Congenit Heart Surg. 2025 May;16(3):323-328. doi: 10.1177/21501351241285451. Epub 2025 Jan 17.
BackgroundImpella 5.5 ventricular assist device (VAD) insertion is typically done via the axillary artery or directly through the aorta; however, an axillary artery must be ≥6 mm in diameter, which excludes many pediatric patients who do not meet this criterion. The innominate artery is a larger vessel that can better accommodate the Impella VAD in pediatric patients. Outcomes of this technique were compared with other pediatric patients undergoing the standard axillary artery cannulation.MethodsThe Heart Center at Le Bonheur Children's Hospital recently adopted the trans-innominate cervical approach for insertion of the Impella 5.5 VAD. We performed a retrospective cohort study comparing these cases to data collected from cases using an axillary approach found in the Advanced Cardiac Therapies Improving Outcomes Network database. Comparisons between preoperative characteristics, postoperative course, adverse events, anticoagulation, and clinical outcomes for these two groups were analyzed.ResultsThirty-nine patients were implanted via the axillary approach; seven patients were implanted via the transinnominate cervical approach at our institution. Patients inserted via the trans-innominate approach had fewer days on the device (median, 8 [range, 3-24]), postimplant intensive care unit days (16 [3-24]), and hospital length of stay (14 [3-28]) compared with axillary insertion patients (12.5 [6.75-29.2], 58.5 [12.5-43.5], and 32 [19.7-83.5], respectively). Trans-innominate patients had fewer adverse events than axillary patients.ConclusionsTrans-innominate cervical approach for insertion of the Impella 5.5 VAD is safe with low rates of adverse events in pediatric patients. As miniaturization of VAD therapy continues to evolve, this technique may provide greater application of these devices for even smaller children.
背景
Impella 5.5心室辅助装置（VAD）通常通过腋动脉或直接经主动脉插入；然而，腋动脉直径必须≥6mm，这排除了许多不符合该标准的儿科患者。无名动脉是一条较大的血管，能更好地容纳儿科患者的Impella VAD。将该技术的结果与其他接受标准腋动脉插管的儿科患者进行了比较。
方法
勒邦赫尔儿童医院心脏中心最近采用经无名颈途径插入Impella 5.5 VAD。我们进行了一项回顾性队列研究，将这些病例与从高级心脏治疗改善预后网络数据库中使用腋动脉途径的病例收集的数据进行比较。分析了这两组患者术前特征、术后病程、不良事件、抗凝情况及临床结局的差异。
结果
39例患者通过腋动脉途径植入；7例患者在我们机构通过经无名颈途径植入。与腋动脉插入患者相比，经无名动脉途径插入的患者使用装置的天数（中位数8天[范围3 - 24天]）、植入后重症监护病房天数（16天[3 - 24天]）和住院时间（14天[3 - 28天]）更少（分别为12.5天[6.75 - 29.2天]、58.5天[12.5 - 43.5天]和32天[19.7 - 83.5天]）。经无名动脉途径的患者不良事件比腋动脉途径的患者少。
结论
经无名颈途径插入Impella 5.5 VAD在儿科患者中是安全的，不良事件发生率低。随着VAD治疗的小型化不断发展，该技术可能为更小的儿童提供这些装置的更广泛应用。
