Download Impella 2.5

Percutaneous Ventricular
Assist Devices
101
M. Courtney Haigney RN, BSN Percutaneous Ventricular
Assist Devices (pVAD’s)
•  Definition of:
§  Percutaneously placed mechanical pump
or device that supports a failing ventricle
§  Most commonly for LV support
§  Designed for short-term use
pVAD’s: Indications For:
•  Acute, decompensated Heart Failure
•  Acute MI (with or without Cardiogenic
Shock)
•  High Risk PCI (Protected PCI)
•  Post Cardiotomy Shock
Currently Available pVAD’s:
•  IABP
•  Impella (2.5, CP) (Abiomed)
•  TandemHeart (CardiacAssist)
•  ECMO
Currently Used pVAD’s
pVAD’s
•  230,000 + patients supported per year
•  Of these, 70% IABP
•  Impella Use is Rapidly Growing
•  ECMO use also increasing
IABP
IABP
•  Description of:
§  Balloon tipped catheter placed in the
descending aorta, that inflates during diastole,
deflates during systole, displacing blood both
antegrade and retrograde
§  In Use since 1968
IABP
IABP: Benefits of:
Coronary and Systemic Perfusion
LV Work, Preload + Afterload,
Myocardial O2 Consumption
IABP
IABP-Proper Timing
IABP
•  Components of:
§  Pump Console
§  Balloon Catheter
IABP- Components
IABP Console
Balloon Catheter
IABP
•  Advantages of:
§  Relatively small Arterial Puncture
§  Timing nearly “Idiot-proof”
§  Ease of Insertion
§  Fluoroscopy not required
IABP
•  Disadvantages of:
§  Effectiveness dependent on precise timing of
inflation and deflation
§  Dependent on Native LV function
§  Hemodynamic Support Inferior to other
Devices (provides 0.5- 1 l/min)
IABP
•  Contraindications of:
§  Aortic Dissection
§  Severe PAD
§  Aortic Insufficiency
Impella
Impella 2.5
•  “The World’s Smallest Heart Pump”
•  FDA approved for use in Cardiogenic
Shock
•  FDA approved for use in High Risk PCI
(Protected PCI)
Impella 2.5
•  Description of:
§  Catheter based, axial flow pump pulls
oxygenated blood from the LV, and expels it
into the ascending aorta
§  Transports blood in the same manner as the
natural heart
Impella 2.5
•  Benefits of
LVEDP, LVEDV, Myocardial Oxygen
Demand, Ventricular Workload
Mean Arterial Pressure
Impella 2.5
•  Components of: §  Automated Impella Controller (Console, “Brain”) §  Impella Catheter §  Connecting Cable §  Purge System Impella: Components of:
Automated Impella Controller
Impella 2.5 Catheter
Impella
Impella 2.5
Impella
maximal flow
FDA approved for LV
ort for up to 6 hours
Impella
by AbioMed
LP 5.0
Impella
ires surgical
! 13 F sheath (percutaneous)
Impella
ntation !! 92.5F cannula
L maximal flow
! 510K FDA approved for LV
for up to 6 hours
max flow ! support
Sold
by AbioMed
Impella
►
Impella LP 2.5
►
Impella LP 2.5
Impella LP 5.0
►
► Impella LP 5.0
Impella
! LP
21 F 5.0
►
Impella LP 5.0
! !1321F Fsheath (percutaneous)
Impella LPsurgical
2.5
! !9 Requires
F►cannula
implantation
! 13 F sheath (percutaneous)
! !2.5
L
maximal
5.0 !max
flow flow
9 F cannula
2.5 L maximal
flow
! 510K! FDA
approved
for LV
! 510Kfor
FDA approved
for
support
6 LVhours
support forup
up toto
6 hours
! SoldAbioMed
by AbioMed
! Sold by
! 21 F ! Requires surgical
implantation
2.5
Impella 2.5
•  Advantages:
§  Familiar Insertion Technique
§  Relatively Quick Set-up (<30 minutes)
§  Superior Hemodynamic Support (vs. IABP)
§  Flows up to 2.5 liters/minute
Impella 2.5
•  Disadvantages
§  Intended for very Short-term Use (hours to 4
days maximum)
§  May cause Hemolysis
§  Requires access to the LV
§  Requires crossing of the Aortic Valve
Impella 2.5
•  Contraindications:
§  LV Thrombus
§  Mechanical Aortic Valve
§  Severe Aortic Stenosis
§  Severe PAD
§  VSD
TandemHeart
TandemHeart
•  Description of:
§  2 Catheter based Left Atrial to Femoral
Artery bypass system
TandemHeart
•  How Does It Work?
§  Catheter placed across the atrial septum
withdraws oxygenated blood from the LA, and
returns the blood through the arterial catheter
into the systemic circulation via the femoral
artery
TandemHeart
•  Benefits of: –  By unloading the LA, and thereby the LV LV Preload, LV Workload, Myocardial O2 Demand MAP, Cardiac Output TandemHeart
•  Components of:
§  Transseptal Cannula
§  Centrifugal Pump
§  Arterial Cannula
§  Control Console
TandemHeart
TandemHeart Console
TandemHeart Pump
TandemHeart
Arterial Catheter
Transseptal/LA Cannula
TandemHeart
TandemHeart
•  Advantages of:
§  May provide support from hours up to 10 days
§  Does not require access to the LV, or crossing
of the Aortic Valve
§  Provides flows up to 4 liters/min
TandemHeart
•  Disadvantages of:
§  Transseptal Puncture required
§  May leave persistent ASD
§  Patient must be > 40 kg
§  Placement is cumbersome
TandemHeart
•  Contraindications to:
§  RA or LA Thrombus
§  Severe PAD
§  Profound Coagulopathy
ECMO
ECMO
•  Extracorporeal Membrane Oxygenator
§  Veno-arterial ECMO provides hemodynamic
and respiratory support
§  Veno-venous ECMO provides respiratory
support only
V-A ECMO
•  How does it work?
§  Venous cannula takes deoxygenated
blood from a central vein, pumps it into the
membrane oxygenator for gas exchange,
and then returns oxygenated blood to the
arterial system
V-A ECMO
•  Benefits of:
§  Provides full cardio and pulmonary support
§  Can provide flows up to 6 liters/min
V-A ECMO
•  Components of: §  Venous Cannula §  Centrifugal Pump §  Membrane Oxygenator §  Arterial Cannula V-A ECMO
V-A ECM0
ECMO- Console
V-A ECMO
•  Advantages of:
§  Allows for longer therapy (days to weeks)
§  Only pVAD that provides both hemodynamic
and respiratory support
§  Placement does not require fluoroscopy
§  Can be used in even the smallest patients
V-A ECMO
•  Disadvantages of:
§  Complex, labor-intensive set-up and maintenance
§  Presence of Perfusionist required
§  By displacing volume into arterial circulation, may
cause increased left ventricular afterload,
increasing myocardial oxygen demand
ECMO
Widely Available pVAD’s
pVAD’s: The Future
•  Impella Use will continue to grow
•  Devices will become more streamlined
•  One day, use of pVAD’s will become
standard of care when treating patients
with CS or in support of HRPCI
Thank you!