Axillary Access, Clinical Research & Data, Surgical Applications

EACTS 2023 Dr. Kaveh Eghbalzadeh: Awake Insertion of Impella 5.5® with SmartAssist®


Kaveh Eghbalzadeh, M.D., PhD, describes his first experiences with awake insertion of the Impella 5.5® with SmartAssist®. Dr. Eghbalzadeh is a cardiothoracic surgeon at University Hospital, Heart Center Cologne.

Dr. Eghbalzadeh demonstrates the procedure for the insertion of the Impella 5.5 with SmartAssist in a patient who is awake and under local anesthesia. We see how he obtains access to the axillary artery and uses 2 shoestring ties to expose it. He makes an incision and sutures an 8 mm graft to the artery, inserts the sheath into the graft, and wires for Impella insertion.

“In my opinion, I truly believe that all not-intubated patients, and patients who are not too agitated, should undergo the procedure with local anethesia,” Dr. Eghbalzadeh emphasizes. He describes his institutional standard procedure for local operations, beginning with administration of a 50:50 ratio of 2% solution of mepivacaine and 1% solution of ropivacaine as well as intravenous remifentanil.

Dr. Eghbalzadeh presents data from 20 patients who have undergone this procedure in Berlin (n=15) and Cologne (n=5). He describes the patients as “a typical cohort of patients undergoing MCS therapy.” The male to female ratio is 4:1 and the mean age of the patients is about 60 years of age. Median lactate levels were 7.1 and the median duration of support was 11 days. All but 1 patient presented in SCAI shock stage D and the mortality was 10%.

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