Axillary Microaxial Left Ventricular Support as a Bridge to Durable Left Ventricular Assist Device in a Child With Cardiomyopathy.

A 14-year-old male patient (body surface area, 1.49 m2; axillary artery diameter, 4.8 mm) with Duchenne muscular dystrophy and dilated cardiomyopathy presenting with refractory cardiogenic shock underwent successful right axillary Impella 5.5 device (Abiomed) insertion as a bridge to advanced therapies. On insertion of the Impella device, his hemodynamics and clinical status rapidly stabilized. After 8 days, he was successfully transitioned to a durable left ventricular assist device. Simple modifications of the standard Impella 5.5 insertion technique, along with the elasticity of the pediatric vasculature, facilitated success of this cardiogenic shock management pathway.