Incidence and Management of Access Site Infection Following Trans-Axillary Implant of a Microaxial Left Ventricular...

The Impella 5.5 is microaxial left ventricular assist device (LVAD) implanted most commonly into the axillary artery (AxA). This study aims to investigate the incidence and management of vascular graft infection (VGI) following circulatory support with the Impella 5.5.

This is a single-center retrospective analysis of 92 patients who were supported by Impella 5.5 between June 2020 and August 2024. Since November 2023, Dacron graft has been tunneled through the pectoralis major muscle via a separate incision in patients expected to require prolonged support. The graft was trimmed and buried beneath the pectoralis major muscle during explant. Support period was classified as short (≤ 14 days, Group SS) or extended (> 14 days, Group ES).

Of the 92 patients, 26 (28.3%) died while on support, Impella was explanted in 66 patients (71.7%): Bridge-to-recovery in 36 (39.1%), bridge-to-durable LVAD in 8 (8.7%), and bridge-to-transplant in 22 (23.4%) including 5 heart and kidney transplant (HKT). Median support duration was 7 [5, 8] days in Group SS (N = 54) and 27.5 [18, 38] days in Group ES (N = 38). No infections were reported in Group SS. Four patients in Group ES who underwent HKT experienced VGI following 39, 47, 51, and 85 days of support. Two patients with tunneled grafts required patch repair of AxA, while the remaining two patients with non-tunneled grafts required extensive extra-anatomical bypass.

Approximately 10% of patients requiring extended support developed VGI. Heart transplant recipients with a high risk of infection such as extended support or HKT will benefit from a comprehensive approach for early diagnosis and therapeutic intervention.