Procedure for Changing an Impella Device While Maintaining Guide Wire Access: A Novel Technique

Abstract

Highlights We describe a novel technique to exchange an Impella over a guide-wire, preserving the arteriotomy access and to lower the risks of vascular complications. We describe this technique in the context of two interesting cases. The first case is of a young man with myocarditis and cardiogenic shock from a previously undiagnosed systemic lupus erythematous. The second case is of a woman with ST elevation myocardial infarction and cardiogenic shock requiring complex percutaneous intervention. The implantation of Impella CP served as circulatory support in these cases as myocardium recovered but was complicated by access site bleeding. We were able to remove the Impella device while maintaining the access sheath to allow for adequate hemostasis prior to sheath removal.  We believe the readers of the journal will find these images and technique interesting and useful in their own practice.