A step-by-step technique for transaxillary Impella 5.5 implantation is described in a patient with cardiogenic shock following ST elevation myocardial infarction, resulting in successful weaning and significant improvement of left ventricular ejection fraction before hospital discharge.
Key Findings
Background
Transaxillary Impella 5.5 implantation was successfully performed in a patient with haemodynamic instability following STEMI with multivessel disease.
Patient was a 56-year-old with no relevant medical history admitted for ST elevation myocardial infarction.
Echocardiography showed severe left ventricular dysfunction due to extensive anterior hypokinesia.
Coronary angiography revealed acute proximal occlusion of the anterior descending artery with total chronic occlusion of both the right coronary artery and circumflex artery.
Initial support with Impella CP during PCI stenting of the anterior descending artery was insufficient, necessitating escalation to Impella 5.5.
Methods
The surgical technique involved anastomosing a 10 mm Dacron graft to the right axillary artery for device access.
A 10 mm Dacron graft was anastomosed to the right axillary artery and extracted by counterincision through the adjacent skin.
A 23Fr introducer was used to progress a curved Teflon-coated guidewire through the aortic valve into the left ventricle.
The curved guidewire was subsequently replaced with a rigid 0.018 guidewire to advance the Impella 5.5.
Advancement of the Impella 5.5 was performed under combined fluoroscopy and echocardiography guidance.
Results
The patient was successfully weaned from the Impella 5.5 support approximately one week after implantation.
Inotropes were gradually tapered off over the days following Impella 5.5 implantation.
The ventricular assist device was explanted approximately one week after insertion.
Significant improvement of the left ventricular ejection fraction was observed before discharge from the hospital.
The case represents a single patient report and is presented as a procedural case description rather than a controlled study.
What This Means
This research describes a detailed, step-by-step surgical technique for inserting a powerful mechanical heart pump called the Impella 5.5 through the axillary artery (located near the shoulder) in a patient whose heart was failing after a severe heart attack. The patient had blockages in multiple coronary arteries and initially received a smaller pump (Impella CP) during a stenting procedure, but their condition continued to worsen, requiring escalation to the larger Impella 5.5 device. The surgical approach involved sewing a synthetic tube graft onto the axillary artery to create a stable access route for the pump, which was then carefully guided into the heart using both X-ray imaging and ultrasound.
This research suggests that the transaxillary route for Impella 5.5 insertion can be used effectively when patients in cardiogenic shock require greater mechanical circulatory support than smaller devices can provide. Under the support of the Impella 5.5, the medical team was able to gradually reduce the patient's dependence on intravenous heart-stimulating medications (inotropes), and the pump was successfully removed about one week later. The patient showed meaningful recovery of heart function before leaving the hospital.
The practical significance of this report lies in its detailed procedural description, which may serve as a technical reference for cardiac surgery teams performing this procedure. Because this is a single case report, it does not establish how commonly these outcomes occur, but it documents that successful implantation, support, weaning, and recovery of ventricular function are achievable using this approach in a critically ill patient.
Furiasse F, Roselló-Díez E, Casellas S, Taurón M, Irabién-Ortiz &, Pueblas E, et al.. (2026). Impella 5.5 insertion: step by step.. Multimedia manual of cardiothoracic surgery : MMCTS. https://doi.org/10.1510/mmcts.2026.044