Innovative Intra-Aortic Circulatory Support Pump: Novel Hemodynamics
Journal of the Society for Cardiovascular Angiography & Interventions
In the past 3 decades, interventional cardiology has evolved in a “golden era” of innovation, providing an ever-expanding portfolio of devices (and drugs) that have transformed disease management. The advent of percutaneous mechanical circulatory support (MCS) devices has shifted the paradigm for the management of hemodynamic compromise and has facilitated the performance of high-risk percutaneous coronary interventions (PCIs).
First came the intra-aortic balloon pump (IABP), which boosts aortic pressure and coronary perfusion by systolic unloading and diastolic augmentation, thereby establishing its value in unstable ischemia and decompensated heart failure. Innovation has relegated the IABP to secondary status. Left ventricular (LV) pumps (eg, Impella) that directly generate cardiac power while concomitantly unloading the ventricle have attained superior hemodynamic benefits, increasing cardiac output (CO) and, thereby, stabilizing aortic perfusion pressure while simultaneously reducing pulmonary congestion (including under conditions of severe mitral regurgitation). Importantly, Impella is highly valuable in high-risk PCI, providing a “safety net” of hemodynamic stability that facilitates more complete revascularization.
Rizik DG, Goldstein JA. Innovative intra-aortic circulatory support pump: novel hemodynamics. J Soc Cardiovasc Angiogr Interv. 2022 Nov-Dec;1(6):100500. doi:10.1016/j.jscai.2022.100500.