Full percutaneous biventricular support with two Impella pumps: the Bi‐Pella approach

Abstract

Extracorporeal membrane oxygenation is used for acute respiratory distress syndrome, refractory cardiogenic shock, and out‐of‐hospital cardiac arrest with uncertain neurological status, and, until recently, it was the only minimally invasive option to achieve biventricular support. However, extracorporeal membrane oxygenation increases left ventricular afterload and requires systemic anticoagulation, which is a major contraindication in the context of thrombolytic therapy following an ischaemic stroke. Conversely, the Impella heart pumps by design unload the ventricle and require minimal anticoagulation. We report the first case of mechanical circulatory supported with Impella CP on the left and Impella RP on the right (Abiomed Inc., Danvers, MA) for acute biventricular failure due to suspected acute myocarditis in the context of thrombolytic therapy for ischaemic stroke.

Con: Impella Mechanical Circulatory Support Is Preferable to Extracorporeal Membrane Oxygenation in Patients With Cardiogenic Shock

“…The strategy of providing percutaneous biventricular support with simultaneous use of right and left ventricular Impella pumps or BiPella support also is increasingly being used. 27 This is not surprising because the Impella devices offer distinct advantages, including ease of placement, familiarity with procedural skills needed for placement, speedy deployment, increased patient mobility, and simplicity of management protocols. In addition, provision of robust cardiac flow support that is rhythm independent makes these devices an attractive option compared with other MCS devices.…”

Biventricular Impella use in pediatric patients with severe graft dysfunction from acute rejection after heart transplantation

“…Impella RP, a device designed for right ventricular (RV) support, is FDA approved for pediatric patients with a body surface area (BSA) ≥1.5 m 2 with RV failure after left VAD implantation, heart transplant, or open heart surgery. Few adult studies and case reports have described the use of bilateral Impella devices, or BiPella, in the management of patients with severe biventricular dysfunction . These reports largely represent patients after acute myocardial infarction, sudden decompensated heart failure, or myocarditis: populations that can be very different from the pediatric population .…”

“…Few adult studies and case reports have described the use of bilateral Impella devices, or BiPella, in the management of patients with severe biventricular dysfunction. [1][2][3] These reports largely represent patients after acute myocardial infarction, sudden decompensated heart failure, or myocarditis: populations that can be very different from the pediatric population. 4 The use of BiPella has only been reported once in the pediatric population as a two patient case series and clearly warrants more investigation.…”

Minimally invasive biventricular mechanical circulatory support with Impella pumps as a bridge to heart transplantation: a first‐in‐the‐world case report

“…1 Treating patients with cardiogenic shock secondary to biventricular heart failure is challenging because of limited options for mechanical circulatory support that can serve as a bridge to cardiac transplantation. [3][4][5][6][7] Case report A 67-year-old female presented with chest discomfort and was diagnosed with complete heart block. 2 The treatment of choice remains OHT, but a significant number do not survive to transplantation.…”

“…The use of biventricular Impella devices in cardiogenic shock as a bridge to recovery and LV assist device has been previously reported. [3][4][5][6][7]…”