Department of Cardiac and Vascular Surgery, Dokkyo Medical University, Mibu, Japan.
Department of Cardiac and Vascular Surgery, Dokkyo Medical University, Mibu, Japan.
J Cardiol. 2024 Apr;83(4):228-235. doi: 10.1016/j.jjcc.2023.10.008. Epub 2023 Nov 4.
The importance of temporary mechanical circulatory support for treating acute heart failure with cardiogenic shock is increasingly recognized, and Impella (Abiomed, Danvers, MA, USA) has received particular attention in this regard. Impella is an axial flow left ventricular assist device (LVAD) built into the tip of a catheter. It is inserted via a peripheral artery and implanted into the left ventricle. Although the morphology of Impella is different from a typical LVAD, it has similar actions and effects as an LVAD in terms of left ventricular drainage and aortic blood delivery. Impella increases mean arterial pressure (MAP) and systemic blood flow, thereby improving peripheral organ perfusion and promoting recovery from multiple organ failure. In addition, left ventricular unloading with increased MAP increases coronary perfusion and decreases myocardial oxygen demand, thereby promoting myocardial recovery. Impella is also useful as a mechanical vent of the left ventricle in patients supported with veno-arterial extracorporeal membrane oxygenation. Indications for Impella include emergency use for cardiogenic shock and non-emergent use during high-risk percutaneous coronary intervention and ventricular tachycardia ablation. Its intended uses for cardiogenic shock include bridge to recovery, durable device, heart transplantation, and heart surgery. Prophylactic use of Impella in high-risk patients undergoing open heart surgery to prevent postcardiotomy cardiogenic shock is also gaining attention. While there have been many case reports and retrospective studies on the benefits of Impella, there is little evidence based on sufficiently large randomized controlled trials (RCTs). Currently, several RCTs are now ongoing, which are critical to determine when, for whom, and how these devices should be used. In this review, we summarize the principles, physiology, indications, and complications of the Impella support and discuss current issues and future expectations for the device.
临时机械循环支持治疗心原性休克合并急性心力衰竭的重要性日益受到重视，在这方面，Impella（Abiomed，美国丹佛）受到了特别关注。Impella 是一种内置在导管尖端的轴流左心室辅助装置（LVAD）。它通过外周动脉插入，并植入左心室。虽然 Impella 的形态与典型的 LVAD 不同，但在左心室引流和主动脉血液输送方面，它具有与 LVAD 相似的作用和效果。Impella 增加平均动脉压（MAP）和全身血流量，从而改善外周器官灌注，促进多器官衰竭的恢复。此外，左心室卸载和 MAP 增加增加冠状动脉灌注，减少心肌氧需求，从而促进心肌恢复。Impella 还可作为接受静脉动脉体外膜肺氧合支持的患者的左心室机械通气。Impella 的适应证包括心源性休克的紧急使用和高危经皮冠状动脉介入和室性心动过速消融术期间的非紧急使用。其在心源性休克中的预期用途包括恢复桥接、耐用设备、心脏移植和心脏手术。预防性使用 Impella 预防心脏手术后心肌梗死后心源性休克也越来越受到关注。虽然已经有许多关于 Impella 益处的病例报告和回顾性研究，但基于足够大的随机对照试验（RCT）的证据很少。目前，正在进行几项 RCT，这对于确定何时、为谁以及如何使用这些设备至关重要。在这篇综述中，我们总结了 Impella 支持的原理、生理学、适应证和并发症，并讨论了该设备的当前问题和未来期望。
