Classic Impella exchange interrupts flow when the old device is pulled into the aorta before advancing the new device across the aortic valve, threatening circulatory collapse and loss of left ventricular access. In "double barrel," uninterrupted Impella exchange, the new device is placed into the ventricle alongside the old, where flow is first transitioned completely. Of 31 consecutive patients undergoing this procedure, none experienced intraoperative cardiac arrest, and 96.8% (30/31) had no new aortic insufficiency. One vascular complication ensued following known preoperative iliac injury. One patient suffered nonembolic stroke; another had subarachnoid hemorrhage. Fifty-five percent (17/31) of patients survived, with 22.6% (7/31) recovering, 25.8% (8/31) undergoing transplant, and 6.5% (2/31) transitioning to durable left ventricular assist device. Impella-only survival (83.3%, 10/12) was significantly higher than Impella-extracorporeal membrane oxygenation survival (36.8%, 7/19; (operating room) OR 14.46, 95% ((confidence interval) CI 1.74-119.93, p = 0.01). We conclude the "double barrel" technique is reliable in device-dependent cardiogenic shock patients, offering significant advantages and minimal risk.

中文翻译：

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双桶 Impella 交换器：一种不间断机械循环支持的可靠方法。


当旧装置被拉入主动脉时，经典 Impella 交换会中断流动，然后使新装置穿过主动脉瓣，威胁循环衰竭和失去左心室通路。在“双桶”不间断的 Impella 交换中，新装置与旧装置一起放入心室，首先在脑室中血流完全过渡。在连续接受该手术的 31 例患者中，无一例出现术中心脏骤停，96.8% （30/31） 无新发主动脉瓣关闭不全。在已知的术前髂骨损伤后发生了 1 例血管并发症。1 例患者患有非栓塞性卒中;另一例有蛛网膜下腔出血。55% （17/31） 的患者存活，其中 22.6% （7/31） 康复，25.8% （8/31） 接受移植，6.5% （2/31） 过渡到耐用的左心室辅助装置。仅 Impella 存活率 （83.3%，10/12） 显著高于 Impella 体外膜肺氧合存活率 （36.8%，7/19;（手术室）OR 14.46,95% （（置信区间） CI 1.74-119.93，p = 0.01）。我们得出结论，“双桶”技术在设备依赖性心源性休克患者中是可靠的，具有显着的优势和最小的风险。