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Updated: Jul 12, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Impella 5.5 insertion: step by step
Fiamma Furiasse1, Elena Roselló-Díez1, Sandra Casellas1
1Department of Cardiac Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Insights
This case study highlights the successful use of the Impella 5.5 heart pump in a patient experiencing severe left ventricular dysfunction following ST elevation myocardial infarction. The advanced mechanical circulatory support facilitated recovery and improved heart function before discharge.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Devices
Background:
- ST elevation myocardial infarction (STEMI) can lead to severe left ventricular dysfunction.
- Hemodynamic instability in STEMI patients often necessitates advanced mechanical circulatory support.
- Complex coronary artery disease, including multiple chronic occlusions, presents significant management challenges.
Purpose of the Study:
- To describe the successful implantation and management of an Impella 5.5 device in a patient with STEMI and severe left ventricular dysfunction.
- To evaluate the efficacy of the Impella 5.5 as a bridge to recovery in a hemodynamically unstable patient.
- To report on the clinical outcomes, including hemodynamic improvement and device explantation.
Main Methods:
- A 56-year-old patient with STEMI and severe left ventricular dysfunction underwent urgent percutaneous coronary intervention with Impella CP support.
- Due to persistent hemodynamic instability, a transaxillary Impella 5.5 device was implanted.
- The implantation involved surgical access via the right axillary artery and device placement under fluoroscopic and echocardiographic guidance.
- Inotropic support was gradually withdrawn during Impella 5.5 therapy.
Main Results:
- Successful implantation of the Impella 5.5 device was achieved.
- The patient's hemodynamic status stabilized, allowing for gradual weaning from inotropic agents.
- The Impella 5.5 device was successfully explanted after one week of support.
- Significant improvement in left ventricular ejection fraction was observed prior to hospital discharge.
Conclusions:
- The Impella 5.5 provides effective mechanical circulatory support for patients with STEMI and severe left ventricular dysfunction.
- Transaxillary Impella 5.5 implantation is a viable option for managing complex cases with hemodynamic instability.
- This approach can facilitate myocardial recovery and improve patient outcomes, enabling device explantation and discharge.
Abstract:
A 56-year-old patient with no relevant medical history was admitted to our hospital due to ST elevation myocardial infarction. Echocardiography showed severe left ventricular dysfunction due to extensive anterior hypokinesia. Coronary angiography revealed acute proximal occlusion of the anterior descending artery with total chronic occlusion of the right coronary artery and the circumflex artery. Due to haemodynamic instability, it was decided to implant a stent in the anterior descending artery under Impella CP support. As the patient's condition worsened, additional support was required. It was decided to perform a transaxillary Impella 5.5 implantation. A 10 mm Dacron graft was anastomosed to the right axillary artery and extracted by counterincision through the adjacent skin. Using a 23Fr introducer, a curved Teflon-coated guidewire was progressed through the aortic valve to the left ventricle. The curved guidewire was then replaced with a rigid 0.018 guidewire that was used to advance the Impella 5.5 under fluoroscopy and echocardiography guidance. Once the correct position was assessed, the therapy was started. As days went by under Impella 5.5 support, inotropes were gradually tapered off and the ventricular assist device could be explanted a week later. Significant improvement of the left ventricular ejection fraction was observed before discharge from the hospital.