Coronary anatomy: Difference between revisions

The Impella device is an axial flow pump on a catheter.  The system has an electromagnetic motor directy coupled to a helical impeller located near the tip of a catheter. When the “snorkel” at the tip of the catheter is placed across the aortic valve and into the left ventricular chamber, the motor rotates the impeller at 50.000 rpm, drawing ventricular blood into the distal end of the catheter and discharging it non-pulsatile into the ascending aorta. The device can be placed via the femoral artery in a 9 Fr sheath. There are 2 versions: a 2.5 and a 5L (33.000 rpm), with maximal outputs of respectively 2.5 and 5.0L/min. Before placement an echocardiography should rule out LV thrombus (1).

In 2012, the PROTECT II trial randomized 452 patients with 3-vessel of left main coronary artery disease and severely depressed left ventricular function to an Impella (2.5L) or an IABP. The Impella provided superior hemodynamic support, but with no difference in the 30 days endpoint of major adverse events (2).

In 2008, a multicenter registry showed the Impella 2.5 to be safe and potentially useful in hemodynamic support in high-risk PCI (multivessel, left main, last remaining vessel, low LV function) with rates of myocardial infarction, stroke, bleeding and vascular complications at 30 days of 6.2% (3).