Temporary left ventricular assist device through an axillary access is a promising approach to improve outcomes in refractory cardiogenic shock patients

Abstract

Cardiogenic shock (CS) causes significant morbidity and mortality and such patients can deteriorate rapidly. Temporary left ventricular assist devices (LVADs) are a promising approach to manage these patients. The following is a case series in which patients stabilized with a temporary LVAD for CS improvement were analyzed retrospectively. Between June 2011 and January 2014, 15 patients received temporary devices through an axillary approach (mean age: 53 ± 15, 93% male). Mean survival time was 317.8 ± 359.5 days (range: 6-936 days). During support there were no major bleeding events, infectious complications at the axillary access site, upper extremity edema, or emboli. The most of the patients recovered from CS (93%) were mobilized (67%) and were extubated (73%) while on temporary device support. Median times to extubation, intensive care unit discharge, and discontinuation of inotropic medications were: 1.63, 18, and 15 days, respectively. Four patients recovered to no device support and five received a long-term LVAD, all of whom remain alive. Therefore, implantation of a temporary LVAD through an axillary approach is a promising therapy for improving outcomes in patients needing mechanical circulatory support as a bridge to recovery or a definitive LVAD.

Figure 1

Patient outcomes. Kaplan–Meier curves demonstrating 30 day patient survival (A) and survival to date (B).

Figure 2

Echocardiographic data. Before, with Impella, postexplantation. **p < 0.01, ***p < 0.001, ****p < 0.0001. A: Ejection fraction. B: Cardiac output. C: Cardiac index. D: Systolic pulmonary artery pressure. E: Diastolic pulmonary artery pressure. F: Pulmonary capillary wedge pressure. Represented as means with standard error of the mean.