Author + information
IMPELLA® is a new vascular micro-axial blood pump with a flow of 2.5 L/min. It allows the unloading of the left ventricle.
11 consecutive male patients (mean age 65±7 years), with coronary artery disease (9 with three vessels disease, 2 with left main stenosis and two coronary vessels disease, 5 of them with last remaining vessel) and severe left ventricular dysfunction (mean EF 24±4%) were enrolled. All were poor surgical candidates because of severe co-morbidities: diabetes 63%, renal insufficiency on dialysis 27%, severe respiratory insufficiency 18%. Coronary artery lesions were 70% type C and 30% type B2. All these patients underwent high-risk PCI with Impella support. Cardiac index (CI), pulmonary wedge pressure (PWP and derived parameters were monitored by Swan-Ganz Catheter, while LVEF was measured from TEE.
Success rate was 100% without any device-related adverse event. The average time of IMPELLA® support was 42±16 min. No pts needed pharmacologic inotropic support. During IMPELLA® there was a significant improvement of CI (from 2.15±0,8 l/min/sm to 2.83±0,3 l/min/sm, p<0.01), stroke volume (from 37.2±15 ml to 49.6±11 ml, p< 0.01), mean blood pressure from 55±8 mmHg to 64±7 mmHg (p< 0.001) while PWP pulmonary vascular resistances significantly decreased (from 24.8mmHg±11 to 20.7±6 mmHg, and 723±146 dyne/sec/cm-5 to 620±93 dyne/sec/cm-5, p<0.01).
Mean coronary occlusion time during IMPELLA® support was 184±18 sec.
During the procedures LV ejection fraction, stroke volume, CI, PWP, mean blood pressure and pulmonary vascular resistance did not show any significant changes.
Left Ventricle Unloading with Impella during complex PCI in pts with severe left ventricular dysfunction is able to improve hemodynamic basal condition, and to maintain it during prolonged coronary occlusion.
- 2013 American College of Cardiology Foundation