Background: Impella 5.5 ventricular assist device (VAD) insertion is typically done via the axillary artery or directly through the aorta; however, an axillary artery must be ≥6 mm in diameter, which excludes many pediatric patients who do not meet this criterion. The innominate artery is a larger vessel that can better accommodate the Impella VAD in pediatric patients. Outcomes of this technique were compared with other pediatric patients undergoing the standard axillary artery cannulation.
Methods: The Heart Center at Le Bonheur Children's Hospital recently adopted the trans-innominate cervical approach for insertion of the Impella 5.5 VAD. We performed a retrospective cohort study comparing these cases to data collected from cases using an axillary approach found in the Advanced Cardiac Therapies Improving Outcomes Network database. Comparisons between preoperative characteristics, postoperative course, adverse events, anticoagulation, and clinical outcomes for these two groups were analyzed.
Results: Thirty-nine patients were implanted via the axillary approach; seven patients were implanted via the transinnominate cervical approach at our institution. Patients inserted via the trans-innominate approach had fewer days on the device (median, 8 [range, 3-24]), postimplant intensive care unit days (16 [3-24]), and hospital length of stay (14 [3-28]) compared with axillary insertion patients (12.5 [6.75-29.2], 58.5 [12.5-43.5], and 32 [19.7-83.5], respectively). Trans-innominate patients had fewer adverse events than axillary patients.
Conclusions: Trans-innominate cervical approach for insertion of the Impella 5.5 VAD is safe with low rates of adverse events in pediatric patients. As miniaturization of VAD therapy continues to evolve, this technique may provide greater application of these devices for even smaller children.
Keywords: axillary artery; innominate artery; pediatric; ventricular assist device.