Abstract 16318: Using Arterial Recoil for Large Bore Access Closure After Impella Assist Device Removal

Abstract

Background: The use of Impella assist device for high-risk percutaneous coronary interventions (HR-PCI) and cardiogenic shock (CS) has increased in the last decade and requires a large bore arterial access (LBA). However, LBA closure following Impella removal is associated with significant complications. Objective: To describe the safety and efficacy of a novel method of LBA closure using arterial recoil following Impella removal. Methods: A descriptive, retrospective review of electronic medical records in all patients that underwent LBA closure using this novel method from July 1, 2018, to June 30, 2022, was performed at the University of Mississippi Medical Center. The procedure involves controlled downsizing of the arterial sheath from 12 French (Fr) to 6 Fr with intermittent compression to allow patent hemostasis facilitated by arterial recoil. Baseline characteristics and outcomes including closure success, immediate or delayed (>6 hours) bleeding, and access site hematoma/pseudoaneurysm were included. Results: Of 103 patients with Impella placement, 20 (19%) underwent LBA closure with the arterial recoil method. Patients were predominantly male (80%) and White (55%) with a mean age of 65 + 16 years. The most common indication for Impella placement was HR-PCI (40%), followed by non-acute myocardial infarction (AMI) CS (35%), and AMI-CS (25%). After downsizing of the femoral sheath to 6 Fr, 14 patients (70%) underwent manual compression, 3 patients had a 6 Fr sheath left in place to maintain access, 2 patients underwent placement of a Perclose device, and 1 patient underwent placement of a Vascade device. Successful LBA closure was performed in all patients with no immediate or delayed bleeding complications. A total of 5 patients (25%) died inpatient, including one patient who had palliative removal of the Impella device; the deaths were unrelated to complications of Impella removal. Conclusions: LBA closure post-Impella removal with this novel method is safe and effective. Further prospective studies are needed to ascertain its comparative efficacy.