Direct Pull-Through Technique to Insert the Impella RP Device Without Using Fluoroscopy

We describe a technique for insertion of the Impella RP device that does not require fluoroscopy. Venous cannulation was performed via the superior vena cava and femoral vein percutaneously. After right atriotomy, the Impella RP is percutaneously inserted and advanced to the right atrium under transesophageal echocardiography guidance. Next, via a longitudinal 2 cm incision in the main pulmonary artery (PA), a large C-shaped clamp is advanced retrograde through the pulmonic and tricuspid valves into the right atrium. The pigtail portion is grasped, pulled through to the main PA, and the device is positioned in the PA under direct vision.