Kishimoto Satoru, Hiraoka Arudo, Chikazawa Genta, Yoshitaka Hidenori
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-5-1 Nakaicho, Kita-ku, Okayama, 700-0804, Japan.
J Artif Organs. 2025 Mar 12. doi: 10.1007/s10047-025-01499-7.
A 69-year-old male diagnosed with subacute myocardial infarction was subsequently transferred to our institution. Upon admission, echocardiography revealed ventricular septal rupture (VSR). The patient was promptly supported via venoarterial (VA) extracorporeal membrane oxygenation (ECMO) and Impella CP before surgical VSR repair on the 12th day of admission. Following surgery, the patient decided to be transferred to the intensive care unit under new VA-ECMO assistance. Subsequently, Impella CP removal and arterial cannula reinsertion were performed at the ipsilateral site, with no pulsatile bleeding observed from the arterial cannulation site. Emergency aortography revealed a contrast defect at the terminal aorta. Owing to the possibility of acute thrombotic occlusion, the Fogarty procedure was performed through the bilateral common femoral artery (CFA); however, no thrombus retrieved. Contrast-enhanced computed tomography revealed complete occlusion of the bilateral common iliac arteries, extending to the abdominal aorta. The uncontrollable, rapid progression of acidemia resulted in sudden cardiac arrest. Acute arterial occlusion leading to fatal outcomes can occur because of thrombosis following long-term Impella CP use. Impella-associated thrombi can form around the shaft of a mixed area of blood flow caused by the interaction between Impella and ECMO and often develop distal to the aortic arch, which is often overlooked during routine examinations. Therefore, planning for long-term Impella with ECMO support must utilize various imaging modalities to search for thrombi and prepare several means of revascularization during Impella removal.
一名69岁男性被诊断为亚急性心肌梗死，随后被转至我院。入院时，超声心动图显示室间隔破裂（VSR）。患者在入院第12天接受VSR手术修复前，迅速通过静脉-动脉（VA）体外膜肺氧合（ECMO）和Impella CP进行支持治疗。手术后，患者决定在新的VA-ECMO辅助下转至重症监护病房。随后，在同侧部位进行了Impella CP移除和动脉插管重新插入，动脉插管部位未观察到搏动性出血。急诊主动脉造影显示主动脉末端有造影剂充盈缺损。由于存在急性血栓闭塞的可能性，通过双侧股总动脉（CFA）进行了Fogarty手术；然而，未取出血栓。增强计算机断层扫描显示双侧髂总动脉完全闭塞，延伸至腹主动脉。无法控制的快速酸血症进展导致心脏骤停。长期使用Impella CP后可能因血栓形成导致急性动脉闭塞，进而导致致命后果。Impella相关血栓可在Impella与ECMO相互作用引起的血流混合区域的轴周围形成，且常发生在主动脉弓远端，这在常规检查中常被忽视。因此，在ECMO支持下长期使用Impella的规划必须利用各种成像方式来寻找血栓，并在移除Impella期间准备多种血管重建方法。
