Perioperative Management of Patients Receiving Short-term Mechanical Circulatory Support with the Transvalvular Heart Pump

Abstract

Use of the transvalvular heart pump to provide short-term circulatory support in the perioperative setting is growing. The considerations for the perioperative management of patients receiving transvalvular heart pump support are reviewed for the anesthesiologist.

Perioperative Extracorporeal Cardiopulmonary Resuscitation in Adult Patients: A Review for the Perioperative Physician

“…[87][88][89] A percutaneous transvalvular heart pump, such as the Impella, directly unloads the left ventricle by pumping blood from the left ventricle into the aortic root and reduces aortic root blood stasis while also contributing to overall systemic flow (the combination of venoarterial ECMO and Impella support is sometimes referred to as ECPella). 73,90 Its use as a left ventricular vent was associated with improved 30-day survival, despite a higher rate of vascular complications and increased need for renal replacement therapy. 91…”

Optimizing Perioperative Care for Ventricular Tachycardia Ablation in High-Risk Patients Supported by Impella 5.5

“…During cardiac procedures, management of cardiogenic decompensation often includes treatment based on underlying causes or providing pharmacological interventions, such as inotropes and vasopressors [ 2 ]. Alternatively, an Impella (Abiomed Inc., Danvers, MA, USA) is a transvalvular heart pump that provides continual flow by aspirating blood from the left ventricle and propelling blood into the aorta, providing temporary circulatory support during cardiac compromise [ 2 ]. Complications of Impella include aortic insufficiency and reduced flow rate due to insufficient preload [ 2 , 3 ].…”

“…Alternatively, an Impella (Abiomed Inc., Danvers, MA, USA) is a transvalvular heart pump that provides continual flow by aspirating blood from the left ventricle and propelling blood into the aorta, providing temporary circulatory support during cardiac compromise [ 2 ]. Complications of Impella include aortic insufficiency and reduced flow rate due to insufficient preload [ 2 , 3 ]. Improper Impella placement can lead to arrhythmia, hypoperfusion, and bleeding [ 2 , 3 ].…”

“…Complications of Impella include aortic insufficiency and reduced flow rate due to insufficient preload [ 2 , 3 ]. Improper Impella placement can lead to arrhythmia, hypoperfusion, and bleeding [ 2 , 3 ]. In contrast to Impella 2.5 (Abiomed Inc., Danvers, MA, USA) and Impella Cardiac Power (CP) (Abiomed Inc., Danvers, MA, USA), which are implanted percutaneously through the femoral artery, Impella 5.5 is placed surgically and is capable of greater maximum flow of up to 6 L/min [ 2 ].…”

“…Improper Impella placement can lead to arrhythmia, hypoperfusion, and bleeding [ 2 , 3 ]. In contrast to Impella 2.5 (Abiomed Inc., Danvers, MA, USA) and Impella Cardiac Power (CP) (Abiomed Inc., Danvers, MA, USA), which are implanted percutaneously through the femoral artery, Impella 5.5 is placed surgically and is capable of greater maximum flow of up to 6 L/min [ 2 ]. We detail the flow rate, position sensing, and other differences between the devices in the "Discussion" section.…”