Safety and Feasibility of Impella CP Decannulation With a Preclosure Technique in Myocardial Infarction With Cardiogenic Shock

Background The Impella CP is a widely used mechanical circulatory support device for patients with cardiogenic shock undergoing high‐risk percutaneous coronary intervention. Hemostasis following Impella removal remains a clinical challenge. Although the preclosure technique using the Perclose ProGlide device is standard in elective procedures, its feasibility in emergency settings for cardiogenic shock has not been well established. Methods This single‐center, retrospective study included 14 consecutive patients with myocardial infarction complicated by cardiogenic shock who underwent Impella CP insertion between January 2020 and December 2024. Patients requiring coronary artery bypass grafting or venoarterial extracorporeal membrane oxygenation were excluded. A single Perclose ProGlide device was deployed using the preclosure technique at the time of Impella insertion. For hemodynamically stable patients, the Impella was removed within 48 h at the bedside. Procedural endpoints comprised door‐to‐preclose, door‐to‐unloading (DTU), and door‐to‐balloon (DTB) times. Safety endpoints were also evaluated. Results 10 patients underwent Impella removal using the preclosure technique, and 4 patients underwent surgical cutdown. Comparing the preclose and surgical groups, the DTU time was not significantly different (median [interquartile range]: 89.5 [86.25–98.75] min vs. 92.0 [74.5–112.5] min, respectively; p = 0.811), nor was the DTB time (107.0 [104.25–119.75] min vs. 109.0 [88.5–131.0] min, respectively; p = 1.000). However, the time to Impella removal was significantly shorter in the preclose versus surgical groups (25.0 [22.0–27.75] h vs. 73.0 [59.0–91.5] h, respectively; p = 0.014). Technical success was achieved in all cases without major bleeding, surgical conversion, or infection. Conclusions This study demonstrated the feasibility and safety of total percutaneous bedside Impella CP removal using a single Perclose ProGlide device in patients with cardiogenic shock. The preclosure technique did not prolong DTB or DTU times and may be a practical alternative to surgical Impella device removal in stable patients.