Outcomes of circulatory support with continuous-flow microaxial devices using hybrid axillary access. A single-center registry

Abstract Introduction The Impella device is a short-term continuous-flow circulatory support system. It can be implanted through a vascular graft to the axillary artery, representing a valid alternative to conventional access routes. Purpose To assess outcomes of Impella devices implanted via hybrid axillary access at our center over the past decade in advanced heart failure patients. Methods We conducted a retrospective single-center registry of all Impella devices implanted between 2015 and 2024. We focused on patients who received an Impella via hybrid implantation through axillary access. Devices were classified by model (Impella CP®, 5.0®, and 5.5®). Main demographic, clinical, and outcome variables were collected for each model. Results A total of 178 Impella devices were implanted in 156 patients over 9 years. Among these, 54 Impella devices were implanted via hybrid axillary access in 40 patients (mean age 60 years, 25% women) as treatment for advanced heart failure. The etiology of cardiomyopathy was idiopathic in 14 patients, chronic ischemic in 11, acute ischemic in 8, and other etiologies in 7 patients. At implantation, 37 patients (92%) were classified as INTERMACS level 2–3. By device type, there were 28 Impella CP®, 5 Impella 5.0®, and 21 Impella 5.5®, with a mean support duration of 13, 17, and 20 days, respectively. Fourteen device exchanges were performed in 11 patients. Causes for exchange included thrombotic dysfunction in 9 cases, expiration of certification date in 1, access-site infection in 2, purge cassette rupture in 1, and accidental traction in 1 case. According to therapeutic goal, in the Impella 5.0® group (3 patients), 2 were transplanted and 1 died (33%). In the Impella CP® group (20 patients), 13 underwent transplantation, 2 achieved recovery, and 5 died (25%). In the Impella 5.5® group (17 patients), 11 were transplanted, 1 recovered, 1 was bridged to long-term support, and 4 died (24%). Overall, there were 10 deaths (25%) during support due to multiorgan failure (n=6), therapeutic limitation (n=3), and hemorrhagic stroke (n=1), while the remaining 30 patients (75%) achieved their intended clinical goal. Conclusions In our center, Impella implantation using hybrid axillary access as treatment for advanced heart failure shows favorable outcomes, achieving the intended therapeutic goal in over 70% of patients.