**3. Impella**

Impella is a pump which pulls blood from the left ventricle and expels into the ascending aorta (**Figure 2**). The system has a continuous-flow microaxial pump located at the distal end of the catheter. The device can be inserted via a standard catheterization procedure through the femoral artery. It is inserted into the left ventricle via a femoral cut down or through the axillary artery, and goes through the ascending aorta, across the valve and into the left ventricle. This pump can produce a flow from 2.5 to 5.0 L/min. The principal feature mechanism of the device is to reduce the ventricular work, and to provide the circulatory support necessary to allow heart recovery.

difference in cardiac index after 30 min of support, and the trial showed a higher cardiac index in patients treated with Impella than with IABP. The overall mortality was 46% in both groups [5]. The IMPRESS in STEMI trial randomized between the IABP and Impella 2.5 in patients with cardiogenic pre-shock. This study was powered for a difference in left ventricular function. However, this trial was stopped prematurely due to a lack of enrollment after 21

Role of Short-Term Percutaneous Mechanical Circulatory Support Devices as Bridge-to-Heart…

http://dx.doi.org/10.5772/intechopen.75094

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The Impella pump can also be used for ventricular support in patients who develop heart failure after heart surgery. The device can provide immediate support and restore the hemodynamic stability for a period of up to 7 days, and this may allow time for creating a definitive treatment strategy [7]. Hence, patients who are waiting for a donor can be supported as a

The Impella RP is a type of Impella pump designed for the treatment of right ventricular failure that can be inserted through the femoral vein. The prospective RECOVER RIGHT study showed that the safe, easily deployed, and reliable pump resulted in good hemodynamic

The Impella pump is not appropriate in patients with mural thrombus in the left ventricle, a mechanical aortic valve, severe aortic valve stenosis or insufficiency, severe peripheral arterial disease, significant right heart failure, combined cardiorespiratory failure, and atrial or

The TandemHeart is a continuous-flow centrifugal-assist device placed percutaneous way. Cannulas are inserted through the femoral vein and advanced across the intra-atrial septum into the left atrium (**Figure 3**). The pump withdraws oxygenated blood from the left atrium and returns to the femoral artery via arterial cannulas. The pump is capable of delivering

The TandemHeart is creating a left atrial-to-femoral artery bypass that provides hemodynamic support during mainly high-risk coronary interventions and cardiogenic shock after

Among all other available percutaneous circulatory support options, only TandemHeart provides a steady supply of oxygenated blood to the body, while decompressing the left ventricle

The device provides active hemodynamic support in patients who have little residual ventricular function and also can remain implanted for up to 3 weeks. For these reasons, if patients in advanced heart failure is too sick for immediate LVAD placement or transplantation, the TandemHeart may serve as a bridge-to-recovery, LVAD placement (as a bridge-to-bridge), or

patients had been enrolled [6].

**4. TandemHeart**

blood flow up to 5.0 L/min.

to reduce the work of the heart.

cardiac surgery.

even transplantation.

bridge-to-heart transplant with Impella device.

benefit in patients with life-threatening right heart failure [8].

ventricular sepal defect (including post-infarct VSD).

Unlike the IABP, the Impella device uses continuous axial flow and consequently does not require pressure timing or electrocardiographic timing, allowing for stable output despite arrhythmias.

The device is mainly used during high-risk percutaneous coronary interventions (PCI) and in cardiogenic shock that is resistant to medical management. The device can also be used to hemodynamic support for the patient with severe left-ventricular dysfunction undergoing catheter ablation of hemodynamic condition [4].

In the setting of CS, two small trials have been performed with the Impella 2.5 pMCS, both using IABP therapy as the control therapy. The ISAR-SHOCK (efficacy study of LV assist device to treat patients with cardiogenic shock) trial randomized 26 patients between IABP and the Impella 2.5 in the setting of CS complicating AMI. The primary endpoint was the

**Figure 2.** İmpella.

difference in cardiac index after 30 min of support, and the trial showed a higher cardiac index in patients treated with Impella than with IABP. The overall mortality was 46% in both groups [5]. The IMPRESS in STEMI trial randomized between the IABP and Impella 2.5 in patients with cardiogenic pre-shock. This study was powered for a difference in left ventricular function. However, this trial was stopped prematurely due to a lack of enrollment after 21 patients had been enrolled [6].

The Impella pump can also be used for ventricular support in patients who develop heart failure after heart surgery. The device can provide immediate support and restore the hemodynamic stability for a period of up to 7 days, and this may allow time for creating a definitive treatment strategy [7]. Hence, patients who are waiting for a donor can be supported as a bridge-to-heart transplant with Impella device.

The Impella RP is a type of Impella pump designed for the treatment of right ventricular failure that can be inserted through the femoral vein. The prospective RECOVER RIGHT study showed that the safe, easily deployed, and reliable pump resulted in good hemodynamic benefit in patients with life-threatening right heart failure [8].

The Impella pump is not appropriate in patients with mural thrombus in the left ventricle, a mechanical aortic valve, severe aortic valve stenosis or insufficiency, severe peripheral arterial disease, significant right heart failure, combined cardiorespiratory failure, and atrial or ventricular sepal defect (including post-infarct VSD).
