However, after the Impella CP pump is positioned in the ventricle, its smaller Impella 9 F catheter shaft … An ideal access point for the access, away from the peel-away slits in the diaphragm. “It’s important to talk about first principles of femoral access and then talk about large bore access in the same conversation,” The single-access technique represents a significant advance for Impella-supported high-risk PCI, eliminating the need for a second access site for PCI and decreasing the potential risk associated with multiple access sites. A 7-F Pinnacle Destination sheath inserted through the Impella sheath. A dry closure technique can also be used from a second access site. At the end of the procedure, the sheath is then removed and the sutures are tightened on the arteriotomy. Cardiovasc Revasc Med. Sheath size is limited to 7 F, as larger sheaths are not compatible with the Impella shaft. This is placed in the vessel proximal to the arteriotomy and inflated at low pressure (2–4 atm). Braided sheaths with an extended hydrophilic coating work well.
It is recommended that the femoral artery be at least 6 mm in diameter to help avoid lower extremity ischemia. With the sheath peeled away, the separate access through the diaphragm is placed away from the Impella placement port to minimize sheath bleeding.By Michael P. Flaherty, MD, PhD, FACC, FSCAIWhen It Comes to Open-Door Access, Culture MattersWith S. Jay Mathews, MD, MS, FACC; Chris Metzger, MD; Waqas R. Qureshi, MD, MS; Jawairia Sahar K. Mirza, MBBS; Gus Theodos, MD, FACC, FSCAI; Brian Kolski, MD; and Suhail Dohad, MD, FACC1.
Typically, the arteriotomy is preclosed with one or two Perclose suture-mediated closure devices. 2019;93:1317-1319.By Joel Sauer, MBA; and Terri McDonald, RN, MBA, CPHQInnovation in Coronary Mechanical Thrombectomy: Indigo® System CAT™ RX Powered by Penumbra ENGINE™After PCI is completed, the guide catheter and sheath are removed from the Impella sheath by simply pulling them out. Standard 8-F guide catheters are very difficult to manipulate through the diaphragm, and guide catheter manipulation can cause an unacceptable amount of interaction with the Impella shaft, which can lead to movement of the Impella.3. You will receive mail with new password.“It’s important to talk about first principles of femoral access and then talk about large bore access in the same conversation,”By completing this form, you are consenting to receiving emails regarding updates to the program, downloadable templates, case reviews, specialists opinions, and best practices.Dr. Sahil Parikh draws on his extensive experience to share best practices on large bore vascular access.Information for healthcare professionals A 7-F standard sheath advanced all the way to the hub of the sheath.Figure 2. Abiomed’s Impella CP Introducer* was recently FDA cleared 1, and is being released to users. This is done by passing a balloon proximal to the arteriotomy and inflating it at low pressure during sheath removal and vessel closure to minimize bleeding. If adequate hemostasis is not achieved, an additional closure device can be deployed over the wire or manual pressure can be performed.2. Please enter your email address. Appropriate Impella position and motor current waveform should be confirmed prior to placement of the interventional sheath, and movement of the Impella must be minimized with sheath advancement.
A micropuncture access needle puncturing the Impella sheath diaphragm.Sheathless guides have been used with varying degrees of success. Likewise, the Impella shaft should be fixed during sheath removal to avoid pulling the Impella back out across the aortic valve.Figure 3. Although this technique is particularly beneficial in patients with limited access options, its ease and safety have made it the standard option for high-risk PCI access for many operators.The Opportunity for Increased Quality Care and Shared Savings With the Impella® Heart PumpThe Benefit of Complete Revascularization and Efficacy of Complete Revascularization in a Single SettingOnce the sheath and guide catheter are in place, there is limited ability to manipulate the Impella. A second access for coronary intervention would then need to be obtained.By Rajan Patel, MD, FACC, FAHA, FSCAIFigure 5. Impella CP: Peel-away Introducer Sheath: 14 Fr x 13 cm, 14 Fr x 25 cm: Insertion: Femoral
Finally, the peel-away Impella sheath can be disrupted, which can lead to bleeding and necessitates removal of the peel-away sheath and advancing the repositioning sheath. Catheter Cardiovasc Interv.The single-access technique also lacks a second access for management of access site complications. 2018;19(5 pt A):540-544.Cardiac Interventions Today (ISSN 2572-5955 print and ISSN 2572-5963 online) is a publication dedicated to providing coverage of the latest developments in technology, techniques, clinical studies, and regulatory and reimbursement issues in the field of coronary and cardiac interventions.Exploring appropriate applications.Renal Protection During Impella®-Supported PCI in Patients With High-Risk Complex Coronary Artery DiseaseFigure 4. If this happens, removing the sheath and sticking at a separate site in the Impella sheath diaphragm may be necessary. Abiomed’s Impella CP Introducer* was recently FDA cleared1, and is being released to users.
Catheter Cardiovasc Interv.