**7. Summary**

The Impella® platform resembles a pVAD system that augments the repertoire of modern interventional cardiology. The landmark PROTECT II study presented evidence that in patients undergoing protected PCI, hemodynamic support with Impella 2.5 leads to improved outcomes at 3 months when compared to IABP. With the Impella® being easy and safe to implant and its overall low rate of adverse events, the system provides interventional cardiologists with a tool for patients at high risk for adverse events during complex PCI procedures.

Adding more powerful (up to 5.0 l/min) and right cardiac support devices to the platform, the range of indications have expanded to cardiogenic shock, right ventricular failure, and a multitude of conditions that result in impaired left ventricular output. Although the principal physiological benefits of left ventricular support of unloading of the left ventricle with Impella® have been examined extensively, there are currently no randomized, controlled trials demonstrating improved survival of patients supported with Impella® in cardiogenic shock. A promising new strategy is combining ECMO with Impella. Further studies should answer the questions of (I) what cohort of patients at (II) what time and stage of cardiogenic shock (III) profit from what respective pVAD.
