The evolving role of percutaneous ventricular assist devices in high-risk cardiac patients

Coronary Artery Disease
Ilan A MarcuschamerRan Kornowski

Abstract

The Impella is a mechanical circulatory support device that supports ventricular function. Since 2008, when the first Impella device received Food and Drug Administration clearance, its use has become increasingly prevalent. A variety of Impella devices are available, and are differentiated by size, power, and insertion techniques. These versions of the Impella have been used in a multitude of clinical scenarios, both emergent and elective, including high-risk coronary interventions, acute myocardial infarction complicated by cardiogenic shock, decompensated left and right heart failure, high-risk ventricular tachycardia ablations, and aortic valvuloplasty. However, the available evidence supporting its use is less than robust, primarily consisting of case reports and registries, with a limited number of randomized-controlled trials comparing the Impella with the intra-aortic balloon pump. Although these trials show that the Impella provides better hemodynamic support compared with the intra-aortic balloon pump, they failed to show a survival benefit for the Impella. This finding may have a number of explanations, foremost the inherent difficulty of selecting appropriate patients for trials that are conducted in extreme clinica...Continue Reading

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Citations

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