The Impella Heart Pump is an external device that is temporarily introduced into the heart, to maintain healthy blood-flow during a high-risk, protected, Percutaneous Coronary Intervention (PCI). It is also used when there is a Myocardial Infarction (heart attack) induced Cardiogenic Shock. We will cover Cardiogenic Shock in a separate article. To understand why the Impella Heart Pump is required, we need to know a little about PCIs.
As the name implies, Percutaneous Coronary Interventions is a procedure (intervention) in which an external device or mechanism is introduced from under the skin (percutaneous) in order to resolve one or more issues in the (coronary) arteries of the heart. They help restore blood flow to the heart muscle, reducing the risk of mortality and improving outcomes from the procedure.
Balloon Angioplasty with Stenting is one of the most high-profile and well-known PCI. But there are several others in vogue today:
Most patients can safely go through a PCI without the support of an external or introduced heart pump. However, some patients who have one or more critical blockages in the coronary arteries, or weak heart muscles, may require additional support. Without this support, the risk of mortality increases.
That is where the Impella Heart Pump comes into the picture. This pump is used to support such patients. It is also used for patients experiencing a heart attack and cardiogenic shock as a result. The pump is used then for additional support, so that the heart can now rest and heal quickly.
The Impella Heart Pump is popular for its sleek design and ease of use. The sleek design minimizes discomfort to the patient and accidental damage to the arteries during insertion. Every model of the device produced by any manufacturer must go through an FDA-approval.
It consists of a short and thin metal tube that is bent at an angle of 30 degrees approximately. Firstly, an incision is made in the upper thigh. The metal tube is inserted into a catheter, and the catheter is gently threaded into the femoral artery all the way to the heart. In the heart, the lower hook-shaped opening called the input, is placed in the left ventricle and the upper, vertical opening, called the output, is placed in the aorta.
During a PCI procedure, the pump is able to achieve a blood-flow or pumping rate of 2.5 to 5 liters per minute depending on the case. Once the procedure is over, and the pump no longer required, its pulled back into the catheter and out of the body. In some patients, the pump is left in place for 4-5 days to ensure stability of heart function.
Although a minimally-invasive procedure, some patients may be hospitalized for a day or two, while most patients are discharged after a couple of hours.
The Impella Heart Pump can be seen as an improvement or a better alternative to the Intra-Aortic Balloon Pump (IABP). It brings many advantages to both the patient and the physician.
In spite of the complications or risks, Impella Heart Pumps are becoming more popular by the day. More randomized controlled trials will be conducted to assess the efficacy of the pump in various coronary situations. Needless to say, the design of these pumps will also evolve, to overcome limitations. For example, concerns around sheath size have been addressed with the latest pumps coming in smaller sheath sizes. Rest assured, these pumps offer a ray of hope to heart patients who undergo various procedures, by reducing risk, improving outcomes and ensuring better quality-of-life post-procedure.
Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.
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