Impella: A Novel Percutaneous Cardiac Assist Device
Written by Bryan Heart cardiologist, Timothy Gardner, MD, FACC
A 68 year-old male experiences a massive anterolateral STEMI and cardiogenic shock. He requires a high dose of Dopamine and Levophed to maintain mean arterial BP of 65 mmhg. An emergent cardiac cath is performed and a 100% occluded proximal LAD culprit lesion is found and treated with a drug eluting stent with no residual stenosis and normal TIMI 3 flow. Revascularization is achieved within four hours of onset symptoms. Ejection fraction is 20% with anteroapical akinesis.
Despite a successful PCI, puts still requires high dose IV pressor and ionotrope support.
What should we do?
This patient has a class 1 indication for a Percutaneous Cardiac Assist Device (PCAD)…Impella.
In the setting of STEMI and Cardiogenic Shock, IV pressors and ionotropes are used to maintain adequate perfusion pressure to increase the myocardial work load and myocardial oxygen demands. This increases the extent of myocardial damage and mortality. The ideal treatment is to provide a mean arterial BP for effective systemic perfusion and at the same time, REDUCE the workload of the heart allowing myocardial recovery. This is termed “unloading” of the left ventricle which reduces infarct size, avoids the systemic toxicity of vasopressors and reduces mortality.
What is Impella?
The Impella device is inserted percutaneously, typically into the common femoral artery and advanced to the heart through the iliac arteries and aorta. The device or “cannula” crosses the aortic valve into the left ventricle. The distal end of the cannula has 3 ‘inlets’ that draw blood from the ventricle and eject it through 3 ‘outlets’ into the aorta past the Aortic Valve. The Impella can provide up to 5 L/M of blood flow greatly improving cardiac output while unloading the left ventricle. The device also will improve coronary blood flow. The Impella is not a permanent Left Ventricular Assist Device and is only used short term until the patient stabilizes and can be weaned off the device as the left ventricle recovers.
The Impella device is also used in patients that are undergoing “High Risk Angioplasty” and serves as a “safety net” in case complications arise during the procedure that cause hypotension or malignant arrhythmias. The Impella maintains adequate perfusion during this period, providing more time for the Interventional Team to treat the patient safely.
Impella at Bryan Heart
Bryan Heart is one of the leading practices in the nation providing this technology to patients. It’s a testament to our commitment of providing the most advanced, proven heart technologies to allow better outcomes for our patients. If you have questions about Impella or would like to refer a patient, call 402-483-3333.