Ventricular Circulatory Support with Impella®: Indications, Management, and Complications

Abstract

The ventricular assist device Impella® is a monoventricular, micro-axial, nonpulsatile pump without oxygenation or decarboxylation function. Based on the principle of Archimedes’ worm, it sucks blood from the left ventricle and it reinjects into the aorta root just in front of the coronary arterial ostia. Depending on the model used (2.5 LP, CP, 5.0 LP), the antegrade flow generated by the Impella® varies from 2.5 to 5 l/min. Due to its operation mode, Impella® also provides an efficient ventricular unloading. Therefore, the adjunction of an Impella® pump in patients treated with an extracorporeal life support (ECLS) reduces the risk of ventricular overload. Its current indications are high-risk coronary angioplasty and cardiogenic shock refractory to cardiovasoactive agents. Insertion of an Impella® via the axillary approach allows active rehabilitation including mobilization and exercise (bike, walk) in patients exclusively assisted with such device or after having been weaned off from an ECLS. In addition, when the Impella® is in situ without an ECLS, it is a valuable help in assessing the right ventricular function in patients for which long-term left ventricular assist device assistance is foreseen.