Then, Amkieh told Massey about the Impella 2.5, the world’s smallest heart pump. The catheter-based device works by temporarily relieving the heart’s pumping function by providing hemodynamic support, allowing doctors the necessary time to perform cardiac interventions. During an operation, the pump delivers up to 2.5 liters of blood per minute of forward flow.

Before Impella, doctors used an intra-aortic balloon pump for support. But, this device did not work well for high-risk patients. “The problem is that whenever you put a stent or balloon in a high-risk patient, you have to have that artery closed while the balloon’s out, and so, for 40 to 60 seconds, the heart might not be getting any blood flow at all,” explained Dr. Jim Smith, a cardiologist with the LHH Physician Group, who has also used the Impella device. “Some people just could not survive that, and you couldn’t treat them. The Impella gives you an opportunity to treat people who couldn’t be treated before.”

In 2011, Amkieh became the first doctor on the North Shore to use the Impella device, with Massey as the first patient. For the procedure, Amkeih inserted the Impella percutaneously in the catheterization laboratory through Massey’s femoral artery into the left ventricle. “It pulls the blood from the left ventricle through an inlet area near the tip, and then it expels the blood from the catheter into the ascending aorta across the valve into the left ventricle,” Amkieh explains. “It’s not inotrope or time-dependent, so it’s not dependent on the heart rhythm.”

The device is indicated for patients with cardiogenic shock, significant left ventricular dysfunction or severe heart failure. “The perfect patient for the Impella would be a person who comes in with acute myocardial infarction and is in cardiogenic shock,” Amkieh said. “When the patient is in shock, the heart cannot pump well, and that’s usually what leads to death. The Impella basically takes over the work of the heart while you are working to open up the artery.”

Using the Impella, Amkieh first performed angioplasty on Massey, followed by triple bypass surgery. “It went very well,” Amkieh said. “The Impella is really relatively easy to use. It does not need a lot of experience. So, it’s easy to learn how to do it.”

Four days after having the operation, Massey went home. “Clinically, he did very well,” Amkieh reported.

In December, Massey had a defibrillator implanted (in an unrelated procedure). He continues to see Amkieh every three months. “I feel much better,” Massey reported. “I’m getting stronger every day.”

Smith performed the second procedure with the Impella at LHH. His patient was a 67-year-old woman who had multi-vessel coronary disease and a chronically occluded right coronary artery. “Had LHH not had this device, I would have just fixed the left anterior descending, and I probably would not have tried to fix the right coronary artery,” Smith said. “But, by having this device in place, I could fix that part, and then I could take the time required to do a total chronic occlusion, which can be a very complex, long case. So, knowing that the patient was supported, I could take my time and just work very carefully until I got it fixed.” The next Impella case will be done at LHH by Dr. Vasantha Bethala of the Cardiovascular Institute.

In a recent clinical trial, Protect 2, researchers compared using the Impella device to the intra-aortic balloon pump. The well-controlled study of 479 patients showed that patients who had procedures using the Impella had better outcomes and fewer adverse effects. “It’s a very slick device,” Smith said. “It’s easy to put in, and it was just very smooth, very intuitive. It’s really a wonderful device. For high-risk surgical patients, it’s worthwhile. It will allow us to (perform procedures on) patients that we couldn’t do before.”

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