{
    "abstract": "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\u00a0=\u00a00.01). We conclude the \"double barrel\" technique is reliable in device-dependent cardiogenic shock patients, offering significant advantages and minimal risk.",
    "authors": [
        {
            "affiliation": "Division of Cardiac Surgery,\u00a0University of Southern California Keck School of Medicine, Los Angeles, California.",
            "firstname": "Jessica S",
            "initials": "JS",
            "lastname": "Clothier"
        },
        {
            "affiliation": "Division of Cardiac Surgery,\u00a0University of Southern California Keck School of Medicine, Los Angeles, California.",
            "firstname": "Serge",
            "initials": "S",
            "lastname": "Kobsa"
        },
        {
            "affiliation": "Division of Cardiac Surgery,\u00a0University of Southern California Keck School of Medicine, Los Angeles, California.",
            "firstname": "Jonathan",
            "initials": "J",
            "lastname": "Praeger"
        },
        {
            "affiliation": "Division of Cardiac Surgery,\u00a0University of Southern California Keck School of Medicine, Los Angeles, California.",
            "firstname": "Markian",
            "initials": "M",
            "lastname": "Bojko"
        },
        {
            "affiliation": "Division of Cardiac Surgery,\u00a0University of Southern California Keck School of Medicine, Los Angeles, California.",
            "firstname": "Mark",
            "initials": "M",
            "lastname": "Barr"
        },
        {
            "affiliation": "Division of Cardiac Surgery,\u00a0University of Southern California Keck School of Medicine, Los Angeles, California.",
            "firstname": "Sanjeet",
            "initials": "S",
            "lastname": "Patel"
        },
        {
            "affiliation": "Division of Cardiac Surgery,\u00a0University of Southern California Keck School of Medicine, Los Angeles, California.",
            "firstname": "Anahat",
            "initials": "A",
            "lastname": "Dhillon"
        },
        {
            "affiliation": "Division of Cardiac Surgery,\u00a0University of Southern California Keck School of Medicine, Los Angeles, California.",
            "firstname": "Jonathan",
            "initials": "J",
            "lastname": "Cash"
        },
        {
            "affiliation": "Division of Cardiac Surgery,\u00a0University of Southern California Keck School of Medicine, Los Angeles, California. Electronic address: Raymond.Lee@med.usc.edu.",
            "firstname": "Raymond",
            "initials": "R",
            "lastname": "Lee"
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2024 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.",
    "doi": "10.1016/j.healun.2024.07.009",
    "journal": "The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation",
    "keywords": [
        "Impella",
        "aortic insufficiency",
        "heart transplant",
        "mechanical circulatory support",
        "percutaneous left ventricular assist device"
    ],
    "methods": null,
    "publication_date": "2024-07-20",
    "pubmed_id": "39029638",
    "results": null,
    "title": "The double barrel Impella exchange: A reliable method for uninterrupted mechanical circulatory support.",
    "xml": "<Element 'PubmedArticle' at 0x788504ad7880>"
}