Transcaval access a safe, effective alternative during Impella implants
Using transcaval access to implant Impella heart pumps is a safe treatment option in the hands of an experienced cardiologist, according to new research published in JSCAI.[1]
“Traditionally, Impella 5.0 devices are implanted surgically via the axillary or femoral arteries,” wrote first author Mustafa Mohammed, DO, with the division of cardiology at Henry Ford Health, and colleagues. “However, surgical placement in critically ill patients poses significant challenges, and arterial access complications are associated with substantial morbidity and mortality. As an alternative, transcaval (caval-aortic) access has emerged, allowing venous entry through the femoral vein and inferior vena cava into the abdominal aorta. This method facilitates transcatheter procedures and mechanical support device placement in patients with poor arterial access due to severe peripheral arterial disease.”
To learn more about this topic, Mohammed et al. tracked data from 72 patients with ischemic or nonischemic systolic acute heart failure. All patients received an Impella 5.0 microaxial flow pump from Johnson & Johnson MedTech using transcaval access at a single facility from 2015 to 2023. The mean age was 58.2 years old, and 66.7% of patients were men. All procedures were performed by experienced interventional cardiologists.
Overall, the authors found that transcaval access and mechanical circulatory support (MCS) delivery were successful in all cases. In-hospital survival was 44.4%, including 43.8% for patients with nonischemic cardiomyopathy and 56.2% for patients with ischemic cardiomyopathy. No vascular complications from the access site were reported, but significant bleeding events from the Impella insertion/removal site occurred in 13.9% of patients.
In addition, 16.7% of patients experienced ventricular tachycardia or ventricular fibrillation during hospitalization, and 5.6% experienced pulseless electrical activity after the implant. The rates of acute kidney injury requiring hemodialysis and stroke were 15.3% and 4.2%, respectively. Finally, the average length of stay was 19.9 days.
“The findings indicate that transcaval access is a feasible and safe approach for MCS in a population with significant hemodynamic compromise and limited options for traditional arterial access,” the authors wrote. “Despite the high baseline risk and complexity of the patient population, transcaval access was successfully performed in all cases, demonstrating its potential as an alternative to surgical or percutaneous arterial access. The in-hospital survival rates and complication profiles offer critical insights into the procedure's viability, particularly in settings where conventional methods are not feasible.”
The group also noted that only a small number of patients underwent medical imaging in advance to help the cardiologist plan ahead. This could potentially impact outcomes, but the teams performing these procedures still delivered favorable outcomes.
To help ensure even better outcomes going forward, the authors recommend collaborating with more experienced centers when necessary and “utilizing existing expertise in the field.” In addition, the group wrote that the establishment of specialized cardiogenic shock centers should help these patients significantly in the years ahead.
“The procedure shows a high success rate and manageable complication profile, underscoring its potential in advanced cardiac care,” Mohammed and colleagues wrote. “Future research should focus on multicenter studies, long-term outcomes, and the development of standardized protocols to further validate and optimize this approach.”
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.