Echocardiographic Guidance for Placement and Management of the Impella 5.5 Microaxial Flow Left Ventricular Assist Device.

Abstract

The Impella 5.5 (Abiomed, Danvers, MA, USA) is the newest iteration of temporary left-ventricular assist devices in the Impella family of devices used for cardiogenic shock. While general guidelines for implantation of mechanical circulatory support devices are available, the authors aim to provide specific and detailed guidance for the Impella 5.5 for the practical application of intraoperative transesophageal echocardiography during placement and transthoracic and transesophageal echocardiography for device monitoring and management. Transesophageal echocardiography is paramount for preimplantation assessment of the right and left ventricles, possible shunt physiology, and valvular pathology. Its use is also helpful in ensuring appropriate device placement, initiating and modifying device settings, troubleshooting device placement, and diagnosing and managing complications.