Objective: Impella 5.0 and 5.5 is a micro-axial catheter-based left ventricular assist device (LVAD) implanted  via vascular graft sutured to axillary artery and providing a blood flow of up to 5.5 l/min. This study aims to investigate the incidence of complications following the circulatory support with Impella 5+ devices.

Methods: Single-centre retrospective analysis of 180 consecutive patients who were treated with a surgically implanted Impella 5.0 or 5.5 between 03/2017 and 02/2021. Patients with access site other than the right or left axillar artery were excluded.

Results: Impella 5.5 was implanted in 44.4% and 55.6% of patients received an Impella 5.0. Pre- or perioperative va/vva-ECMO was necessary in 63 (35%) patients, in 15 installed by means of ECMELLA 2.0 and in 3 patients a central cannulation was used. Revision for bleeding at Impella 5+ access side was necessary in 13 (7.2%) patients. The median Impella support was 8 days. Out of 180 patients, 75 (41.7%) patients died on Impella support. Out of the remaining 105 patients, 47 (26.1%) were successfully weaned from Impella 5+ and 58 (32.2%) required a long-term LVAD. In these patients, the Impella was explanted and the vascular graft shortened, ligated and left under the pectoralis muscle at the bedside in local anesthesia. The median follow-up was 198 days. Out of 105 patients, nine (8.6%) suffered from a graft infection requiring a complete (n=7) or partial (n=2) explantation of the retained graft with a median time to infection of 103 days since Impella explantation. Our analysis did not identify any risk factors for a graft infection. Seven patients (6.7%) developed a plexus brachialis injury resulting in neurological dysfunctions of the upper right or left extremity.

Conclusion: Low incidence of graft infections following bedside Impella 5+ explantation with retaining of the vascular graft justifies the complete removal of the graft only in cases of manifested local infection.