Feasibility of transcaval access for the delivery of mechanical circulatory support in cardiogenic shock
Afana M, Altawil M, Basir M, Alqarqaz M, Alaswad K, Eng M, O'Neill WW, Lederman R, Greenbaum A. Feasibility of transcaval access for the delivery of mechanical circulatory support in cardiogenic shock. J Am Coll Cardiol. 2018;71(11)
J Am Coll Cardiol
Background: Vascular access for the delivery of mechanicalcirculatory support (MCS) in patients who present with cardiogenic shock (CS) is often challenging due to peripheral arterial disease and systemic vasoconstriction. Transcaval access for the delivery of MCS may serve as an alternative access in such patients. The Impella 5.0 device has previously been exclusively inserted via surgical techniques; however, we present the frst case series implanting this device through a percutaneous strategy via transcaval access. Methods: Between December 2015 and June 2017, ten selected patients with progressive or refractory cardiogenic shock underwent percutaneous implantation of MCS with an Impella 5.0 via a transcavalaccess. Demographic, clinical, pre-and post-procedural variables, along with in-hospital outcomes were retrospectively collected and presented. Results: Patients were predominately female (60%) with mean age of 54 + 12 years. MCS was indicated in the setting of cardiogenicshock secondary to idiopathic non-ischemic cardiomyopathy (n=4), myocarditis (n=2), ischemic cardiomyopathy (n=2), post-heart transplant rejection (n=1), and unknown etiology (n=1). Mean duration of support was 85.2 + 53.2 hours. Survival to device explant occurred in seven patients (70%) with successful caval-aortic site closure in six patients and one patient with sheath left in place due to close proximity to renal arteries. Survival to hospital discharge occurred insix patients (60%). Among the survivors, 5 patients (83%) had recovery of native cardiac function and 1 patient (17%) required implantation of a durable left ventricular assist device. Transcaval access was obtained, and delivery ofMCS was successful in all patients without major complication. Conclusion: Transcaval access for the deliveryof MCS in patients without adequate femoral access, or those who may potentially need long-term support, is feasible in patients who present with cardiogenic shock.