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Review
. 2025 Aug 25;18(16):1955-1970.
doi: 10.1016/j.jcin.2025.06.040.

Comprehensive Cardiac Imaging Before and During Microaxial Flow Pump Support for Cardiogenic Shock

Luca Baldetti  1 , Alessandro Beneduce  2 , Guglielmo Gallone  3 , Christophe Vandenbriele  4 , Hatem Soliman-Aboumarie  5 , Giacomo Ingallina  6 , Anna Palmisano  7 , Antonio Esposito  7 , Elena Busnardo  8 , Claudia Francescon  9 , Marina Pieri  10 , Silvia Ajello  9 , Eustachio Agricola  11 , Nicolò Piazza  12 , Jamie Hernandez-Montfort  13 , Claudius Mahr  14 , Jacob Eifer Møller  15 , Anna Mara Scandroglio  9
Affiliations
Review

Comprehensive Cardiac Imaging Before and During Microaxial Flow Pump Support for Cardiogenic Shock

Luca Baldetti et al. JACC Cardiovasc Interv. .

Abstract

The increasing use of microaxial flow pumps (mAFP) underpins the need for a comprehensive approach to manage critically ill patients in an effort to maximize the benefits of this temporary mechanical circulatory support (tMCS) while minimizing its potential complications. Multimodality cardiac imaging offers an irreplaceable array of tools to address device position, device-heart hemodynamic interaction, myocardial recovery assessment, and identification of complications. This review provides a comprehensive and pragmatic summary of the cardiovascular imaging modalities currently available throughout the pathway of care of mAFP-supported patients, from device insertion, to intensive cardiac care hemodynamic monitoring, weaning guidance, and myocardial recovery assessment. The specific logistical and technical challenges related to pump management and potential interference with the imaging technology performed during mAFP are also discussed. Comprehensive cardiovascular imaging represents a fundamental pillar to ensure the best care to mAFP-supported patients and plays a pivotal role in any successful critical care and tMCS program.

Keywords: Impella; echocardiography; fluoroscopy; mechanical circulatory support; microaxial flow pump; multimodality imaging.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Baldetti has received consultancy fees from Abiomed and NuPulseCV; and speaker fees from PIAM pharmaceuticals. Dr Vandenbriele has received speaking fees, personal and institutional grants from Abiomed. Dr Pieri has received speaker fees/consultancy fees from Abiomed. Dr Hernandez-Montfort has received consultancy fees from Abiomed, Abbott, and Boston Scientific. Dr Mahr has received investigator/consultancy grants from Abbott and Abiomed. Dr Møller has received institutional research grants from Abiomed and Novo Nordic Foundation; and is on the advisory board of Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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