Randomized Trials of Percutaneous Microaxial Flow Pump Devices: JACC State-of-the-Art Review

Mohit Pahuja; Adam Johnson; Ryan Kabir; Sukhdeep Bhogal; Jason P Wermers; Nelson L Bernardo; Itsik Ben-Dor; Hayder Hashim; Lowell F Satler; Farooq H Sheikh; Ron Waksman

doi:10.1016/j.jacc.2022.08.807

Randomized Trials of Percutaneous Microaxial Flow Pump Devices: JACC State-of-the-Art Review

J Am Coll Cardiol. 2022 Nov 22;80(21):2028-2049. doi: 10.1016/j.jacc.2022.08.807.

Authors

Affiliations

¹ Department of Cardiology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA. Electronic address: https://twitter.com/MohitpahujaMD.
² Georgetown University School of Medicine, Washington, DC, USA.
³ Department of Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA.
⁴ Department of Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA. Electronic address: https://twitter.com/BhogalSukhdeep.
⁵ Department of Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA. Electronic address: https://twitter.com/JasonWermers.
⁶ Department of Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA. Electronic address: https://twitter.com/NelsonLBernardo.
⁷ Department of Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA. Electronic address: https://twitter.com/DorBen.
⁸ Department of Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA. Electronic address: https://twitter.com/HashimHayder.
⁹ Department of Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA. Electronic address: https://twitter.com/fsheikh22.
¹⁰ Department of Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA. Electronic address: ron.waksman@medstar.net.

PMID: 36396205
DOI: 10.1016/j.jacc.2022.08.807

Abstract

The use of mechanical circulatory support devices in cardiovascular practice has risen exponentially over the past decade. These devices are currently used for hemodynamic support in patients with cardiogenic shock, high-risk percutaneous coronary intervention, left ventricular unloading, protection of kidneys, and right ventricular failure. The Impella (Abiomed) percutaneous microaxial flow pump devices are rapidly gaining popularity. However, despite their increasing use, there are limited randomized clinical trials (RCTs) to support the benefits of the therapy and growing concern regarding complication rates. Vascular problems, including bleeding and acute limb ischemia, are associated with the devices, but published reports also highlight risks for cardiac perforations, mitral chordae rupture, and stroke. In this review, we summarize the history, mechanism of action, previously published RCT data, and upcoming RCTs on these devices.

Keywords: Impella; cardiogenic shock; high-risk percutaneous coronary intervention; mechanical circulatory support.

Publication types

Review

MeSH terms

Heart Failure* / therapy
Heart-Assist Devices* / adverse effects
Hemodynamics
Humans
Randomized Controlled Trials as Topic
Shock, Cardiogenic / etiology