title: Use of Impella Recover(R) LP 2.5 left ventricular assist device during high-risk percutaneous coronary interventions; clinical, haemodynamic and biochemical findings.
abstract: OBJECTIVE
  To investigate in terms of clinical, haemodynamic and biochemical profile the safety and efficacy of the Impella Recover(R) LP 2.5 left ventricular assist device during elective high risk percutaneous coronary interventions (HR-PCI).
  
  
  RESULTS
  Ten out of twelve patients were initially enrolled to receive PCI supported by the Impella catheter; eight underwent pressure-volume (PV) loop analysis while one patient was monitored by intra-cardiac echocardiographic. Free haemoglobin (fHb), B-type natriuretic pepetide, catecholamines, aldosterone, angiotensin II, and endothelin were assessed before, every 40 minutes as average during the procedure and at 3, 12, 24 and 48 hours after intervention. The Impella catheter was used for 144+/-88 min [median (IQR) 108 (85-198)], and was removed immediately after the procedure in all but one patients. In 6, 3 and 2 patients, fHb levels increased above 1, 5 and 10 times the upper limit of normal (ULN), respectively. No significant effect was found on the tested biomarkers in Impella-supported procedures. The PV analysis showed the occurrence of an acute volume increase in the majority of patients immediately after Impella insertion that tended to persist even at maximal pump speed. This was confirmed by the intracardiac echocardiography that was performed in one patient.
  
  
  CONCLUSIONS
  Our data, although preliminary due to the limited sample size, does not encourage the routine use of Impella Recover(R) LP 2.5 in HR-PCI. Additional studies are required to confirm and elucidate the mechanisms responsible for the acute LV volume loading and to quantify the degree of haemolysis induced by the pump in a broader set of patients.
authors.affiliation: Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Paul
authors.initials: P
authors.lastname: Steendijk
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Pascal
authors.initials: P
authors.lastname: Vranckx
authors.forename: Frans
authors.initials: F
authors.lastname: Boomsma
authors.forename: Emile
authors.initials: E
authors.lastname: Onderwater
authors.forename: Sophia
authors.initials: S
authors.lastname: Vaina
authors.forename: Jurgen M
authors.initials: JM
authors.lastname: Ligthart
authors.forename: Eugene
authors.initials: E
authors.lastname: McFadden
authors.forename: Martin
authors.initials: M
authors.lastname: van der Ent
authors.forename: Peter
authors.initials: P
authors.lastname: de Jaegere
authors.forename: Georgios
authors.initials: G
authors.lastname: Sianos