Case Study: Success with Impella® Heart Pumps

The percutaneous circulatory support system Impella can provide safety during coronary interventions by enabling stable hemodynamics. Read more about how the Impella 2.5® heart pump was successfully applied during a PCI in the Segeberger Clinics by Prof. G. Richardt and his team.

Case Study: Success with Impella® Heart Pumps

The Case

The 76-year-old patient suffered from dyspnoea (NYHA III), angina pectoris (Class III) and shortness of breath during exercise. After a complex recanalization of the proximal, right coronary artery (RCA) due to a myocardial infarction two weeks prior, a stent thrombosis occurred. The patient had to be resuscitated and received a new long-line RCA intervention.

Even after this procedure, the patient was not yet able to sufficiently withstand stress and the stent occlusion reoccurred. The LV angiography showed:

  • Occlusion of the stented right coronary artery
  • High-grade M1 stenosis and complex bifurcation of the left coronary artery
  • The left main coronary artery was the last remaining patent vessel

Risk factors

  • Reduced ejection fraction (40%)
  • Condition post lung partial resection in non-small-cell lung carcinoma
  • Suspected pleural carcinoma on both sides
  • Thoraxdrainage located for two months
  • Peripheral arterial occlusive disease
  • Condition post stroke
  • Heparin-induced thrombocytopenia (HIT) II

The Heart Team discussed the case and due to the risk factors, it was decided to proceed with a PCI instead of a CABG.

Intervention team

  • Prof. Dr. Gert Richardt
    Chief Physician at the Department of Cardiology and Angiology, Segeberger Kliniken, Bad Segeberg
  • Dr. Mohammed El Mawardy 
    Senior Physician
  • Dmitry Sulimov 
    Assistant Physician

Treatment Plan

For the intervention, the team worked according to the following plan:

  • "Worst first": Bifurcation stenting of the LAD / D1 bifurcation (Culotte stenting)
  • PCI of the marginal branch (M1)
  • Possibly PCI of the left main (LMT)

Accompanying:

  • Anticoagulation with bivalirudin
  • Hemodynamic support with the Impella heart pump
Impella 2.5® heart pump
Impella 2.5® heart pump

Why Protected PCI with the Impella heart pump?

The patient had a reduced heart function with an ejection fraction of 40%. In addition, multiple vessels were occluded (3-vessel disease with RCA occlusion), so reserves were missing to compensate for a short-term closure of other vessels during a conventional PCI. Since a bifurcation had to be treated, it could also be anticipated that the procedure would potentially take longer.

In such a situation, the Impella heart pump can help with potential complications while also maintaining the stability of hemodynamics during the entire intervention. In addition, the patient's heart has been given the opportunity to recover because the Impella heart pump lowers the oxygen demand of the heart while reducing wall pressure and wall tension, which thereby improves the oxygen supply. Find out more about Protected PCI with Impella heart pumps here.

The Impella 2.5 heart pump was used to support the weakened heart of the patient and gave the attending physician enough time for the implementation of the  complex PCI.

Position of the Impella heart pump during a Protected PCI
Position of the Impella heart pump during a Protected PCI

Result

  • Despite the complex intervention on a vital vessel, the hemodynamics were perfect throughout the entire procedure.
  • The Impella 2.5 catheter continuously pumped about 2.4 liters of blood per minute from the heart into the aorta.
  • The mean arterial blood pressure remained within the normal range at 80 mmHg.
  • The stenosed vessels could be opened.

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