A New Technique for Anticoagulation and Prevention of Bleeding During Impella 5.5 Left Ventricular Assist Device Implantation.

The Abiomed Impella 5.5 (Danvers, MA) is a temporary left ventricular assist device (LVAD) used to support patients during acute cardiogenic shock. It is a catheter-based micro-axial blood pump that is surgically implanted to provide up to 5.5 liters per minute (LPM) of cardiac augmentation. The pump is most frequently inserted through a right subclavicular incision to the axillary artery. Anticoagulation is used during the implant procedure and then maintained at a lower concentration during the duration of support. Inadequate anticoagulation can result in pump thrombosis with subsequent thromboembolization. Excess anticoagulation can result in surgical site bleeding and potential hematoma formation. This case series details three patients with a low-dose anticoagulation strategy. There were no adverse embolic or hemorrhagic events in the peri- or postoperative period.