ECPELLA 2.0—Minimally Invasive Biventricular Groin-Free Full Mechanical Circulatory Support with Impella 5.0/5.5 Pump and ProtekDuo Canula as a Bridge to Bridge Concept: A First-in-Man Method Description

Objectives: Cardiogenic shock (CS) from biventricular heart failure that requires acute mechanical circulatory support (MCS) is associated with a high mortality. Different MCS methods and techniques have emerged as standard of care in CS. Nevertheless, routine MCS approach carries multiple limitations, such as limb ischemia, missing of left ventricular unloading and immobilization. We describe a method to establish a groin free-full support MCS in CS patients without the need for thoracotomy. This is a first report of ECPELLA 2.0 concept, a peripheral groin-free biventricular MCS in patients with acute CS.

Methods: The transluminal placement of the Impella 5.0/5.5 heart pump (Abiomed, Danvers, Massachusetts, United States) crossing the aortic valve into the left ventricle is performed via axillary artery access and under transesophageal echocardiography (TEE) and fluoroscopy guidance.

The ProtekDuo cannula, in combination with any centrifugal pump, offers the advantage of minimally-invasive percutaneous full right heart support. The ProtekDuo cannula crosses the tricuspid valve, RV and pulmonary valve into the main pulmonary artery.

Our one-stage implantation protocol includes initial Impella implantation followed by percutaneous implantation of the ProtekDuoâ canula via the right internal jugular vein (IJV) under fluoroscopy and TEE guidance.

Results: We discuss two patients in acute CS (INTERMACS I) treated with two peripheral MCS devices (Impella 5.0 or 5.5 surgically via axillary artery and ProtekDuoâcannula percutaneously via right internal jugular vein) as a bridge prior to the implantation of a durable LVAD.

BIVAD-support duration was 9 and 15 days and both of the patients were successfully bridged to a durable LVAD. As our BIVAD-concept is groin-free, the patients started full mobilization as early as they were weaned from the respirator 2 days after the BIVAD-Implantation. ECPELLA 2.0 provides a high cardiac output, right and left ventricular unloading with end-organ recovery and a possibility of administration of a membrane oxygenator. There were no device-related complications.

Conclusion: The ECPELLA 2.0 biventricular support concept for patients suffering from an acute CS. allows for rapid extubation, mobilization and physical exercise while on full support. Additional application of a membrane oxygenator is easily feasible if required.