PMC6364115_01
Coronary angiography demonstrating an occluded LAD (red arrow) with collaterals to the RCA (green arrow).
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CP was inserted via the left femoral artery, and coronary angiography/intervention was performed via the right femoral artery. Coronary angiography revealed 70% stenosis of the distal left main coronary artery, chronic total occlusion of the left anterior descending artery, 80% calcific stenosis of the left circumflex, and chronic total occlusion of the right coronary artery (Figure 1).
(a) Receiving limb of the external left femoral artery to right superficial femoral artery bypass. (b) Donor limb of the external left femoral artery to right superficial femoral artery bypass.
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fig2
The ex vivo bypass circuit was created by connecting the 14-French left femoral sheath (donor which originally housed the Impella CP) to the 5-French right femoral antegrade sheath (recipient) (Figures 2(a) and 2(b)).
Chest X-ray showing RP Impella with the inlet situated in the inferior vena cava (red arrow) and the outlet in the pulmonary artery (green arrow) and Impella 5.0 with the inlet in the left ventricle and the outlet in the ascending aorta (yellow arrow).
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In the cardiac ICU, Impella 5.0 and RP support was maintained (Figure 3).