The Impella 5.0 Device: Surgical and

Cardiogenic Shock Applications

Anson Cheung, MD

Surgical Director of Cardiac Transplantation and Mechanical

Circulatory Assist Program of British Columbia

Associate Professor of Surgery

St. Paul’s Hospital

University of British Columbia

Vancouver, Canada

Disclosures

• Abiomed

Speaker’s Bureau

2

Surv

iva

l

Time (Hours)

Initial Insult (Pump Failure)- AMI, myocarditis, post-partum cardiomyopathy, etc

Circulatory Insufficiency- Hypotension, end-organ hypoperfusion

Acute Heart Failure Cascade

Activation of Inflammatory Cascade- Endothelial dysfunction, vasoplegia, tissue edema, worsening pump failure

Worsening Circulatory Insufficiency- Hypotension, end-organ hypoperfusion

Total Circulatory Collapse

Death

Impella 5.0 Device

Acute Cardiogenic Shock

Decision

1. Recovery

- End-organs

- Myocardial

2. Bridge

- Implantable VAD

3. Transplant

Impella Microaxial Flow Pumps

Impella 2.5 and 5.0 are investigational devices in the United States. Impella RD is not FDA approved.

Co

ns

ole

Pu

mp

s

LP 2.5

LP 5.0LD 5.0 RD

12 F = 4 mm

21 F = 7 mm

Femoral Cutdown – Purse-string

Technique

Femoral Cutdown – Graft Technique

Vancouver Experience

Oct, 07 – Sept, 09

28 IMPELLA LP 5.0 devices

were implanted

Etiology of Cardiogenic Shock

Age 53.5 ± 13.9 (13-77)

Male Sex 24 (86%)

BSA (m2) 2.1 ± 0.2

Previous MI 14 (58%)

COPD 8 (33%)

Previous OHS 7 (29%)

Diabetes Mellitus 6 (25%)

Patient Demographics

At Implant

Cardiac Index (l/min/m2) 1.7 ± 0.7

LVEF (%) 19 ± 10

SV02 (%) 54 ± 6

SBP (mmHg) 85 ± 18

Mean Number of Inotropes 3

IABP 16 (57%)

Other Device Support 2 (8%)

Acute Renal Failure 22 (79%)

Intubation 27 (96%)

Cath Lab Implant 3 (11%)

Hemodynamics

Cardiac Index (l/min/m2) 2.7 ± 0.7

SV02 (%) 69

Continuous Renal Replacement

Therapy

10 (22 ARF)

Duration of Support (days) 4.4 ± 3 (1 – 11)

On Support

28 IMPELLA LP 5.0 Patients

Bridge to Recovery

Weaned/Explanted

(15)

Bridge to Bridge

Implantable VAD

(7)

Died on

Support

(6)

30-day Survival – 61%

Survival to Discharge – 56%

All discharge patients in NYHA Class I, II

Died

3

Discharged

Home

(11)

Died

(3)

Discharged

Home

(4)

In-patient

(1)

Device Related Complications….

• No mechanical failure

• No pump repositioning required during

support

• Pressure sensor malfunctioning in 4 Impella

LP5.0

False pump misplacement alarms

No flow display on console

No negative hemodynamic effect

No pump replacement

Device Related Complications….

• No peripheral vascular complications

• No cerebrovascular events

• No reoperation for bleeding or tamponade

Clinical Case

• 41 y/o male with ADHF

• EF ~ 10%, LVEDD 71 mm

• Prev. IVDU, current smoker and marijuna user, poor

social support, depression

• Cath

– Normal coronaries

– Endomyocardial biopsy

– CI 1.7, PAWP 28

• 6 hrs post cath

• Cardiogenic shock on multiple, high dose inotropes

Clinical Case

• Impella LP5.0 inserted in Cath lab

• Post-implant Care

– CCU

• Recovery in 5 days (EF at explant - 40%)

• Explanted in CCU (local anesthetics)

• Discharged home in 10 days

• ~2 yr F/U – EF 47% NYHA I

Summary

• Impella 5.0 microaxial flow pump provide

sufficient circulatory support in patients

with severe cardiogenic shock

• In our early experience, Impella LVAD is

easy and safe to operate with no major

device related adverse events

• The ease of implant, explant and transport

may be advantageous over other current

devices

Thank You

Impella RD

• Right ventricular

support

• Days to months

• Allows ambulation