Insertion of Impella 5.5 via the Axillary Artery Graft Under Fluoroscopic Guidance

The Impella 5.5 (Abiomed, Danvers, MA) is a percutaneous, continuous micro-axial left ventricular assist device. The Impella 5.5 provides systemic end-organ perfusion by moving blood from the left ventricle (LV) into the aorta, thereby unloading the ventricle. The pump has been approved by the United States Food and Drug Administration for short-term, LV support. The insertion of an Impella 5.0 or 5.5 device requires surgical and endovascular skillsets to properly expose the axillary artery, suture a graft in a chimney fashion, and ensure the endovascular delivery of the device over a wire across the aortic valve into the LV under flouroscopic guidance. In this article, we detail a step-by-step guide to implant the Impella 5.5 device via the open surgical approach and including the endovascular technique. Anticipated pitfalls and safeguard measures are highlighted and detailed.