USA: Novel Post-Closure Technique for Impella CP

A novel post-closure technique for removal of next-generation Impella CP and immediate hemostasis may reduce vascular complications tied to device removal and may improve clinical outcomes in these patients, the researchers claim in a new study.

"The post-closure technique uses the side port of the next generation Impella CP to introduce a 0.035″ guidewire to maintain femoral vascular access," the researchers explain in their study published in the journal Cardiovascular Revascularization Medicine.

"The Impella CP is removed, a 14F sheath is placed and a second 0.035″ wire is introduced through the 14F sheath in an over-the-wire, rapid exchange fashion," they wrote. "This allows for a double-wire approach to deploy two suture-mediated closure devices at the time of the extraction of the device for immediate hemostasis in the cath lab."

There has been an exponential growth in the use of percutaneous mechanical circulatory support. Vascular complications remain a growing concern and there are no best practices for device removal. In the study, Colin S. Hirst, Ascension Saint John Heart and Vascular Institute, Ascension Saint John Hospital, Detroit, MI, USA, and colleagues describe a novel post-closure technique for the next generation Impella CP removal and immediate hemostasis. They aimed to determine if the post-closure technique reduces access site adverse vascular events (AVE) and bleeding when compared to manual compression upon device removal of the next generation Impella CP.

For this purpose, the researchers conducted a single-center, retrospective, exploratory analysis of 11 consecutive patients receiving an Impella CP for either high-risk PCI or cardiogenic shock and then referred for post-closure. They were compared to 20 patients receiving manual compression for Impella CP removal between 2017 and 2019. The mean age range was 62.7–65.4 years and 50–65% were male.

Salient Findings of the Study

• The average duration of Impella CP treatment ranged from 3.4 to 5.2 days.
• Patients referred for post-closure had significantly lower rates of all-cause adverse vascular events (0% versus 40%; n = 0/11 versus n = 8/20).
• There was no significant difference in BARC 3 or greater bleeding, transfusion requirement, hospitalization duration, or intensive care duration between removal strategies.

"The novel post-closure technique significantly decreases vascular complications associated with device removal and may improve clinical outcomes for these critically ill patients," the authors concluded.

Reference

Hirst CS, Thayer KL, Harwani N, Kapur NK. Post-closure technique to reduce vascular complications related to Impella CP. Cardiovasc Revasc Med. 2021 Nov 3:S1553-8389(21)00686-2. doi: 10.1016/j.carrev.2021.10.008. Epub ahead of print. PMID: 34810113.