Interventional cardiologists at BWH are first in New England to use Impella Recover 2.5 during high-risk angioplasty.
Brigham and Women’s Hospital (BWH) interventional cardiologists are pioneering the use of minimally invasive ventricular assist devices (VADs) in high-risk angioplasty. Recently, a multidisciplinary team of BWH specialists, including Frederic S. Resnic, MD, MSc, Director of the BWH Cardiac Catheterization Laboratory, successfully implanted the world’s smallest ventricular assist device (VAD) during a high-risk angioplasty procedure. It was the first use of the new device in the New England area and only the second in the United States.
New device
Dr. Resnic, says, “This new device – the Impella Recover 2.5 – promises to help us treat patients who could not otherwise be treated with percutaneous coronary intervention. This group of high-risk patients may also be at unacceptably high risk for surgery, so they have very limited revascularization options. We are evaluating this device as part of the PROTECT I trial. BWH is one of only six sites nationally participating in this FDA-approved safety evaluation.”
Indications
According to Dr. Resnic, appropriate candidates for PROTECT I are patients who are at very high risk for major complications including heart attack and death during angioplasty, who have only one remaining vessel supplying blood to the heart, and who have weakened heart function prior to the procedure.
Dr. Resnic says, “If blood supply to the one remaining vessel were compromised during the procedure, the result would be a catastrophic heart attack, cardiogenic shock, and death. The Impella device appears to provide a very impressive safety net, providing adequate hemodynamic flow (up to 2.5 liters per minute) to support the patient during angioplasty.”
Procedure
The following are steps involved in the procedure.
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The Impella catheter is introduced through the femoral artery and advanced through the aortic valve into the left ventricle,
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A tiny axial flow pump in the catheter spins at about 40,000 rpm, unloading the ventricle and providing adequate hemodynamic support for the patient throughout the procedure,
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With the pump catheter in place, clinicians advance the treatment catheter to the appropriate vessel and perform the revascularization,
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Following the revascularization, the pump is explanted, although it can remain in place for several days if necessary.
BWH team
The first Impella implantation at BWH was a collaborative effort involving interventional cardiologists, a peripheral vascular specialist, a cardiac anesthesiologist, an echocardiographer, and the entire percutaneous advanced therapy cardiac catheterization team. The case took about two and a half hours to complete, and the patient was well enough to go home in two days and continues to do well.
Trial information
Dr. Resnic says, “Although PROTECT I is a safety trial and is not intended to address efficacy, we are encouraged that this device may allow us to offer a safe coronary intervention for patients with very high-risk coronary artery disease complicated by advanced ventricular dysfunction or for those at high risk for surgery. Patients suffering a massive heart attack with cardiogenic shock may also benefit from Impella implantation, although this application awaits further investigation.” This study is currently enrolling patients.
Dr. Resnic notes, “We believe that if the Impella device proves to be safe and effective, it will be a valuable addition to our armamentarium for treatment of high-risk angioplasty patients.” Besides the Impella, BWH cardiologists also have experience with the TandemHeart the only currently FDA-approved interventional option for high-risk angioplasty patients. To enquire about PROTECT I or about enrolling a patient, please contact Dr. Resnic at (617) 732-7133 or at fresnic@partners.org.
Referrals and Information
The Brigham and Women’s Cardiac Catheterization Laboratory welcomes physician inquiries and referrals. Please contact our Physician Referral Service at 1-800-MD-TO-BWH.
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