**1. Introduction**

The Impella® system consists of a miniaturized micro-axial pump of varying size reaching from 11 French (F) to 21 F in diameter mounted on a 9 F catheter (**Figure 1**). The propeller contained in the pump revolves at up to 50,000 rounds per minute (rpm) and draws blood into the inlet area to expel it through the outlet area of the device. The micro-axial pump itself is connected through the catheter to an automated Impella® controller (AIC) that steers the pumps output as well as the required purge fluid flow and integrates information on the pumps position (**Figure 2**). The Impella® catheter is inserted either through the femoral or axillary artery by surgical cut down or percutaneously using a modified Seldinger technique. Being forwarded into the left ventricle under fluoroscopic guidance, the Impella® is positioned to expel blood bypassing the aortic valve.

**Figure 1.** An Impella® 2.5 micro-axial peripheral ventricular assist device consisting of a blood inlet and an outlet area as well as the 12 Fr pump motor mounted on a 9 Fr catheter (Image courtesy of Abiomed, Danvers, Massachusetts, USA).

Peripheral Ventricular Assist Devices in Interventional Cardiology: The Impella® Micro-Axial Pump http://dx.doi.org/10.5772/67883 183

**1. Introduction**

182 Interventional Cardiology

tioned to expel blood bypassing the aortic valve.

The Impella® system consists of a miniaturized micro-axial pump of varying size reaching from 11 French (F) to 21 F in diameter mounted on a 9 F catheter (**Figure 1**). The propeller contained in the pump revolves at up to 50,000 rounds per minute (rpm) and draws blood into the inlet area to expel it through the outlet area of the device. The micro-axial pump itself is connected through the catheter to an automated Impella® controller (AIC) that steers the pumps output as well as the required purge fluid flow and integrates information on the pumps position (**Figure 2**). The Impella® catheter is inserted either through the femoral or axillary artery by surgical cut down or percutaneously using a modified Seldinger technique. Being forwarded into the left ventricle under fluoroscopic guidance, the Impella® is posi-

**Figure 1.** An Impella® 2.5 micro-axial peripheral ventricular assist device consisting of a blood inlet and an outlet area as well as the 12 Fr pump motor mounted on a 9 Fr catheter (Image courtesy of Abiomed, Danvers, Massachusetts, USA).

**Figure 2.** The Automated Impella Controller® steers the pumps output as well as the required purge fluid flow and integrates information on the pumps positions (Image courtesy of Abiomed, Danvers, Massachusetts, USA).

The Impella® platform consists of multiple devices featuring maximal output of up to 5.0 l/min and may be selected according to the required hemodynamic support. While the Impella® 2.5 (2.5 l/min of transvalvular flow) is designed to deliver support in patients mainly undergoing protected percutaneous coronary intervention (PCI), the 3.5 CP (cardiac power, 3.5 l/min of transvalvular blood flow) and 5.0 LP/LD (LP: left peripheral and LD: left direct, 5.0 l/min of transvalvular blood flow) are designed for patients in cardiogenic shock (CS). The Impella® 5.0 LD is the only device that is inserted through an open cardiac procedure into the aorta while the Impella® 5.0 LP is inserted by surgical cut down of the femoral or axillary artery.

A 3.5 l/min Impella® RP (right percutaneous) is implanted through a transvenous femoral approach into the right ventricle to support patients with right ventricular failure (RVF). The Impella® RP transports blood from an inlet in the inferior vena cava (IVC) to an outlet in the pulmonary artery bypassing the right atrium and ventricle and is currently the only device available for percutaneous hemodynamic support of the right heart. Both left and right ventricular pumps may be implanted simultaneously for support during biventricular cardiac failure [1].
