Abstract
The Impella device is a catheter-based miniaturized ventricular assist device. Using
a retrograde femoral artery access, it is placed in the left ventricle across the
aortic valve. The device pumps blood from left ventricle into ascending aorta and
helps to maintain a systemic circulation at an upper rate between 2.5 and 5.0 L/min.
This results in almost immediate and sustained unloading of the left ventricle, while
increasing overall systemic cardiac output. The most common indications for using
the Impella device are in the treatment of acute myocardial infarction complicated
by cardiogenic shock and to facilitate high risk coronary angioplasty. Other indications
include the treatment of cardiomyopathy with acute decompensation, postcardiotomy
shock, and off-pump coronary bypass surgery. A growing body of observational and registry
data suggest a potentially valuable role for the Impella system in reducing the mortality
associated with cardiogenic shock. However, there are, as of yet, no randomized controlled
trial data supporting this observation.
Keywords
Impella device - mechanical circulatory support - ventricular assist device - cardiogenic
shock - high risk coronary angioplasty - postcardiotomy shock - Archimedes' screw
