Author + information
- Received August 30, 2016
- Accepted September 8, 2016
- Published online November 23, 2016.
- Castigliano M. Bhamidipati, DO, PhD, MSc,
- Moses Mathur, MD, MS,
- Ravi S. Hira, MD,
- James M. McCabe, MD and
- Jay D. Pal, MD, PhD∗ ()
- Division of Cardiology, Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle, Washington
- ↵∗Reprint requests and correspondence:
Dr. Jay D. Pal, Department of Surgery, Division of Cardiothoracic Surgery, University of Washington Medical Center, 1959 NE Pacific Street, Box 356310, Seattle, Washington 98195-6310.
A 35-year-old man with a history of Kawasaki disease presented in cardiogenic shock following ST-segment elevation myocardial infarction. He underwent percutaneous intervention of the culprit vessel. He subsequently sustained cardiac arrest, during which time an Impella 5.0 device (Abiomed, Danvers, Massachusetts) was placed percutaneously via the right common femoral artery. The patient continued to experience ventricular tachyarrhythmias, and venoarterial extracorporeal life support was initiated. The Impella was left in the left ventricle to aid in decompression.
Over the next 5 days, biventricular function improved enough to consider weaning mechanical support. The Impella driveshaft was manually pulled back, but intraoperative transesophageal echocardiography failed to show a corresponding change in pump body position. Attempts to readvance the Impella were similarly unsuccessful. The Impella motor current was then noted to be flat, which is worrisome for pump failure. When surveyed under fluoroscopy, we noted a fracture at the distal edge of the 21-F pump motor (now located in the right iliac artery near the repositioning sheath). The pigtail and inlet were still in the left ventricle (Figure 1).
The common femoral artery was exposed and controlled. To maintain wire access to the vessel lumen, the repositioning sheath was cut and removed. The Impella driveshaft was used as a rail to insert a 10-F sheath into the common femoral artery. A 0.035-inch J wire was then placed adjacent to the driveshaft into the descending thoracic aorta. With luminal wire access secured, the 10-F sheath was removed, followed by the 21-F Impella motor. A 26-F Gore DrySeal sheath (W. L. Gore & Associates, Flagstaff, Arizona) was advanced over the J wire. A 6-F multipurpose-2 guide catheter was inserted in the left ventricle, and a 36-mm Gooseneck snare (ev3 Endovascular, Plymouth, Minnesota) was directed to the left ventricular apex. The pigtail was then snared and removed through the femoral sheath (Figures 2 and 3⇓⇓).
Neither fracture of an Impella device nor its successful transcatheter retrieval has been previously described (1,2). We highlight this case to demonstrate the importance of multidisciplinary collaboration and creative hybrid solutions for favorable patient outcomes.
Dr. Hira is a speaker for Abiomed. Dr. McCabe is a proctor for Edwards Lifesciences. Dr. Pal is a consultant to Heartware and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Bhamidipati and Mathur contributed equally to this work.
- Received August 30, 2016.
- Accepted September 8, 2016.
- American College of Cardiology Foundation
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