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Advanced Therapeutic Options in Acute Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Tiffany Dong, Aditi Nayak, Alanna Morris
The Impella is a rotatory, axial-flow pump that propels blood from the LV to the aorta (Figure 9.2). The system includes a flexible pigtail end that sits in the LV and connects to a distal cannula that comes in three different sizes. The cannula houses the pump inlet and outlet, motor, and pump pressure monitor. A proximal 9-Fr catheter contains the motor leads as well as the purge and pressure lumens. This catheter attaches to a console cable and side arms for purge solution and pressure tubing. The device is commonly placed through the femoral artery via a cut-down or in the axillary artery, which allows patients to ambulate, and is advanced retrogradely to cross the aortic valve. The pump rotates at a set speed and draws blood out of the LV into the aorta.
Catheter-based reperfusion in acute myocardial infarction
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Ming-Yu (Anthony) Chuang, Richard Brogan, Derek P. Chew
As a consequence of the negative findings of IABP, other mechanical circulatory support (MCS) devices have gathered increasing interest.85 One of the devices that has been trialled in a sizable randomised trial is the Impella® device. The Impella® device is inserted via a standard 9 Fr femoral sheath, and consists of an axial pump on a pigtail catheter that crosses the aortic valve, with the intention to unload the left ventricle (LV) by continuously drawing blood from the LV and delivering it into the ascending aorta (non-pulsatile) with flow rates up to 4.0 L/minute.82,90 While the device theoretically provides superior haemodynamic support compared to IABP, it has failed, so far, to demonstrate superior short-term survival compared to IABP in the ‘IMPRESS in Severe Shock trial’.90 At present, no MCS devices have been shown to improve survival in CS (including LVAD and ECMO).82,83
Haemodynamic support for high-risk percutaneous intervention
Published in Ever D. Grech, Practical Interventional Cardiology, 2017
John M Lasala, Alejandro Aquino
The Impella® (Abiomed®) is a percutaneous ventricular support device that utilises a micro-axial pump to move blood from the left ventricle to the aorta. There are three classes available that provide increasing levels of support: Impella 2.5 (2.5 L/min), Impella CP (~3.5 L/min) and the Impella 5.0 (5.0 L/min). All three have been approved in the United States to provide haemodynamic support for up to 6 hours. Additionally, based on the data from trials such as PROTECT I and PROTECT II,20,25 the Impella 2.5 has also been approved for use in haemodynamically stable patients undergoing elective or urgent HR-PCI.
Trends in the Use of Short-Term Mechanical Circulatory Support in the United States – An Analysis of the 2012 – 2015 National Inpatient Sample
Published in Structural Heart, 2019
Muhammad Siyab Panhwar, Tanush Gupta, Adham Karim, Sahil Khera, Rishi Puri, Brahmajee K. Nallamothu, Venu Menon, Umesh N. Khot, Deepak L. Bhatt, Samir R. Kapadia, Srihari S. Naidu, Ankur Kalra
Our finding that in-hospital mortality has remained stable from 2012 to 2015 (in both the AMI-CS and non-AMI-CS cohorts) while the use of pVAD and ECMO/PCPS has been increasing merits further discussion. There are limited data regarding the clinical benefit of these devices.19–26 While these devices offer superior improvement in hemodynamic parameters (such as cardiac index, arterial blood pressure, and lactate level) compared with IABP, improvement in survival has not yet been shown. A meta-analysis by Thiele et al.26 of four randomized controlled trials22–25 comparing TandemHeart or Impella with IABP found no clinical benefit, and in fact found that use of all devices was associated with increased bleeding and vascular complications. Further, in a recent retrospective analysis of patients with AMI-CS, Schrage et al. observed that the use of the Impella device was not associated with lower 30-day mortality compared with matched patients who received IABP. They also noted an increase in bleeding and vascular complications with the use of the Impella device.27 Our results as well do not support the concept that utilization of newer, more expensive MCS devices (instead of IABP) improves survival in patients with cardiogenic shock. It must, however, be noted that risk-adjusted in-hospital mortality remained similar despite worsening patient risk profile over time, and that might mask the expected improvement in mortality over time with the increased use of pVAD and ECMO/PCPS.
Percutaneous temporary circulatory support devices and their use as a bridge to decision during acute decompensation of advanced heart failure
Published in Baylor University Medical Center Proceedings, 2018
As TMCS devices evolved, the Impella Recover System was developed in Europe and has been increasingly utilized in patients with acute heart failure, acute coronary syndromes, and protected percutaneous coronary intervention (PCI). The Impella system has a caged blood flow inlet placed retrograde into the LV. The pump aspirates blood from the LV, which is then injected by means of a micro-axial pump into the ascending aorta. The device may be implanted via the femoral, brachial, or axillary approach. The Impella platform consists of three commercially available pumps providing various degrees of hemodynamic support. Impella 5.0 offers a full systemic circulatory support (up to 5 L/min), direct LV unloading, and minimally invasive implantation without sternotomy.13 The axillary approach allows for patient mobility with profound device stability. This is crucial in patients who are awaiting transplant or left ventricular assist device (LVAD) placement and who may be dependent on this device for several weeks. There have been reports of successful use of Impella 5.0 for hemodynamic support in cardiogenic shock in order to prolong the time needed to make a decision for long-term management.14–16 The cost associated with this technology is considerable ($35,000–$50,000 per device console), and the disposable components range from $1000 to $32,000.17 The index admission cost for patients being treated with a percutaneous ventricular assist device was around $91,000 with an average length of stay of 13 days.18
Overview of Impella and mechanical devices in cardiogenic shock
Published in Expert Review of Medical Devices, 2018
Hymie Habib Chera, Menachem Nagar, Nai-Lun Chang, Carlos Morales-Mangual, George Dous, Jonathan D. Marmur, Muhammad Ihsan, Paul Madaj, Yitzhak Rosen
MCS devices embody a progressive domain of clinical and research procedures used to manage CS, and can now be implanted in the cardiac catheterization laboratory. Impella is an MCS device which is temporarily implanted in the ventricle to aid in pumping blood when left ventricular (LV) function is depressed. It is one of the tiniest MCS system developed and consists of a small blood pump located within a catheter that is approximately 6 mm in diameter. The Impella device can pump up to 5 L of blood per minute, depending on the specific generation of Impella device. Our work explores the practicality of the Impella device and other MCS devices used in the treatment of CS, describes their mechanism, and elaborates key publications on these devices. We conclude that early use of Impella improves hemodynamic parameters in CS especially in high-risk PCI procedures or before initiation of inotrope, and may improve overall outcomes.