Utilization of the Impella for hemodynamic support during percutaneous intervention and cardiogenic shock: an insight

Abstract

Impella is a catheter-based micro-axial flow pump placed across the aortic valve, and it is currently the only percutaneous left ventricular assist device approved for high-risk percutaneous coronary intervention and cardiogenic shock. Areas Covered: Even though several studies have repeatedly demonstrated the excellent hemodynamic profile of Impella in high-risk settings, it remains underutilized. Here we aim to provide an up-to-date summary of the available literature on Impellas use in High risk settings as well as the practical aspects of its usage. Expert Commentary: Percutaneous coronary interventions in high rsk settings have always been challenging for a physician. Impella 2.5 and CP, have been proven safe, cost effective and feasible in High Risk Percutaneous coronary Interventions with an excellent hemodynamic profile.

Impella-Induced Incessant Ventricular Tachycardia

“…Use of the Impella 2.5 and Impella Cardiac Power (CP) devices (ABIOMED) to provide mechanical circulatory support for patients in cardiogenic shock and patients undergoing high-risk percutaneous coronary interventions in the United States has increased since US Food and Drug Administration (FDA) approval in 2015. [1][2][3] Impella device placement prior to high-risk percutaneous coronary interventions provides hemodynamic support and myocardial ischemic protection, with a resultant considerable survival benefit. [1][2][3] Manufacturer guidelines indicate that optimal placement for the Impella inlet is 35 mm below the aortic valve annulus away from papillary muscle and the subannular structures.…”

“…[1][2][3] Impella device placement prior to high-risk percutaneous coronary interventions provides hemodynamic support and myocardial ischemic protection, with a resultant considerable survival benefit. [1][2][3] Manufacturer guidelines indicate that optimal placement for the Impella inlet is 35 mm below the aortic valve annulus away from papillary muscle and the subannular structures. 1,2 The Impella outlet area should be well above the aortic valve.…”

“…[1][2][3] Manufacturer guidelines indicate that optimal placement for the Impella inlet is 35 mm below the aortic valve annulus away from papillary muscle and the subannular structures. 1,2 The Impella outlet area should be well above the aortic valve. 1,2 Initial Impella device placement is usually performed under fluoroscopy guidance in the catherization laboratory.…”

“…1,2 The Impella outlet area should be well above the aortic valve. 1,2 Initial Impella device placement is usually performed under fluoroscopy guidance in the catherization laboratory. Although interventional cardiologists are gaining more experience with the device, complications such as high purge pressures, sensor failure, suction episodes, low volume, device thrombosis, and aortic or mitral valve injury are being reported in the literature.…”

“…Although interventional cardiologists are gaining more experience with the device, complications such as high purge pressures, sensor failure, suction episodes, low volume, device thrombosis, and aortic or mitral valve injury are being reported in the literature. 1,2 Other access-related complications include bleeding and vascular complications (limb ischemia, pseudoaneurysm, and arteriovenous fistula). 1,2,[4][5][6] However, as with any percutaneous mechanical circulatory support device, Impella displacement is the most common complication and often occurs secondary to patient movement or transportation.…”