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Review
. 2022 Mar 23:9:856870.
doi: 10.3389/fcvm.2022.856870. eCollection 2022.

Ventricular Unloading Using the ImpellaTM Device in Cardiogenic Shock

Adrian Attinger-Toller  1 , Matthias Bossard  1 , Giacomo Maria Cioffi  1 , Gregorio Tersalvi  1 , Mehdi Madanchi  1 , Andreas Bloch  2 , Richard Kobza  1 , Florim Cuculi  1
Affiliations
Review

Ventricular Unloading Using the ImpellaTM Device in Cardiogenic Shock

Adrian Attinger-Toller et al. Front Cardiovasc Med. .

Abstract

Cardiogenic shock (CS) remains a leading cause of hospital death. However, the use of mechanical circulatory support has fundamentally changed CS management over the last decade and is rapidly increasing. In contrast to extracorporeal membrane oxygenation as well as counterpulsation with an intraaortic balloon pump, ventricular unloading by the Impella™ device actively reduces ventricular volume as well as pressure and augments systemic blood flow at the same time. By improving myocardial oxygen supply and enhancing systemic circulation, the Impella device potentially protects myocardium, facilitates ventricular recovery and may interrupt the shock spiral. So far, the evidence supporting the use of Impella™ in CS patients derives mostly from observational studies, and there is a need for adequate randomized trials. However, the Impella™ device appears a promising technology for management of CS patients. But a profound understanding of the device, its physiologic impact and clinical application are all important when evaluating CS patients for percutaneous circulatory support. This review provides a comprehensive overview of the percutaneous assist device Impella™. Moreover, it highlights in depth the rationale for ventricular unloading in CS and describes practical aspects to optimize care for patients requiring hemodynamic support.

Keywords: Impella; cardiogenic shock; expert group; hemodynamics; mechanical circulatory support device; review; ventricular unloading.

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Conflict of interest statement

MB has received speaker fees from Abbott Vascular, Abiomed, and SIS Medical. FC has received speaker and/or consultant fees from Abbott Vascular, Abiomed, Boston Scientific, and SIS Medical. RK has received institutional grants from Abbott, Biosense-Webster, Biotronik, Boston, Medtronic, SIS Medical, and consultant fees from Biosense-Webster and Biotronik. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Pressure-volume relationship: Normal conditions (CO 5l; green), CS (CO 3l, PAWP 27 mmHg; purple), CS on VA-ECMO support (3l flow, orange); CS on Impella™ CP support and “P” Level 9 (4 l flow; turquoise). The pressure-volume area represents an estimate of mechanical work performed by the ventricle. The pressure-volume area is only reduced with the Impella™, thus decreasing LV work. CO, Cardiac output; CS, Cardiogenic shock; LV, Left ventricular; PAWP, Pulmonary artery wedge pressure; VA-ECMO, veno-arterial extracorporeal membrane oxygenation.
Figure 2
Figure 2
Pressure-volume relationship on Impella™ CP support and different performance (“P”) level settings: The evolution of the pressure-volume relationship before (CS: CO 3l, PAWP 27 mmHg; purple) and after support with “P” Level 4 (2.5 l flow; green) and “P” Level 9 (4 l flow; turquoise). CO, Cardiac output; CS, Cardiogenic shock; PAWP, Pulmonary artery wedge pressure.
See this image and copyright information in PMC

References

    1. Mebazaa A, Combes A, van Diepen S, Hollinger A, Katz JN, Landoni G, et al. . Management of cardiogenic shock complicating myocardial infarction. Intensive Care Med. (2018) 44:760–73. 10.1007/s00134-018-5214-9 - DOI - PubMed
    1. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. . 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European society of cardiology (ESC). Eur Heart J. (2018) 39:119–77. 10.1093/eurheartj/ehx393 - DOI - PubMed
    1. van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, et al. . Contemporary management of cardiogenic shock: a scientific statement from the american heart association. Circulation. (2017) 136:e232–e68. 10.1161/CIR.0000000000000525 - DOI - PubMed
    1. Werdan K, Gielen S, Ebelt H, Hochman JS. Mechanical circulatory support in cardiogenic shock. Eur Heart J. (2014) 35:156–67. 10.1093/eurheartj/eht248 - DOI - PubMed
    1. Touchan J, Guglin M. Temporary mechanical circulatory support for cardiogenic shock. Curr Treat Options Cardiovasc Med. (2017) 19:77. 10.1007/s11936-017-0576-9 - DOI - PubMed

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