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September 2, 2009 > Pumping Life Back into Heart Patients

Pumping Life Back into Heart Patients

Washington Hospital Uses New Tool to Extend Lives

A tiny device about the width of a drinking straw could be the key to helping people that suffer a devastating heart attack. Washington Hospital's Heart program is using a new heart pump that can help a weakened heart function while damage is repaired.

"There are basically two reasons to use a heart pump," says Dr. Ash Jain, Medical Director of the Cardiac Catheter Lab and Peripheral Vascular Services at Washington Hospital. "The first case would be when the patient's heart function is less than 30 percent and the left ventricle needs help pumping blood out to the body, while the heart arteries are being fixed with angioplasty. Heart pumps also may be used for high-risk patients to keep the blood flow going during balloon angioplasty procedures."

Dr. Jain is now conducting two clinical trials of the Impella 2.5 Cardiac Assist Device invented by Abiomed, Inc. Washington Hospital is the only facility in the Bay Area conducting both the studies.

The Impella 2.5 is a miniature heart pump that helps the left ventricle chamber of the heart pump blood from the heart and through the aorta (the main artery leading from the heart) into the body. When inserted into the heart, the device speeds up the flow of blood and makes it easier for the heart to do its job. While in place for hours or days, a seriously damaged heart gets crucial time to recover. Or, it can give doctors time to perform procedures such as opening blocked arteries, which might otherwise kill the critically ill patient.

The device has received clearance from the U.S. Food and Drug Administration (FDA) to provide immediate, minimally invasive circulatory support for critical patients.

Dr. Jain notes that surgeons currently use two types of cardiac assist devices:
* A heart pump that is surgically inserted directly into the open chest.
* An intra-aortic balloon pump (IABP) that is inserted with a catheter through an incision in the groin into the aorta to augment blood flow.


No Incision Necessary

"Inserting the Impella 2.5 device doesn't require an incision," adds Dr. Jain. "It is inserted percutaneously - meaning just under the skin with a needle-puncture
into the groin. Then it is guided up through the femoral artery into the left ventricle. The Impella 2.5 sucks blood from the left ventricle and pumps it out at the rate of 2.5 liters per minute. The IABP also is inserted via catheter, but it has limitations of supporting heart function. Since the IABP is placed in the aorta, rather than the heart's left ventricle itself, it doesn't replace the function of the heart, but augments heart function."

The two studies being conducted will compare the performance of Impella 2.5 devices with that of IABPs in different circumstances:
* Recover II - Inserting the device when a patient comes in with a heart attack and requires angioplasty and has extensive damage in cardiogenic shock.
* Protect II - Inserting the device prior to performing balloon angioplasty in high-risk patients.

"IABPs do not work well when the patient's heartbeat is irregular, if the aortic valve is not functioning, or if the heart muscle is weak," Dr. Jain says. "We are trying to see if the Impella works better in these conditions, as well as in general use. Other trials have shown that because there is no incision or surgery, patients can anticipate faster healing, fewer complications and less risk of infection. Whenever there is an option, minimally invasive procedures generally are the better choice."

Dr. Jain has been conducting clinical trials of various medical devices - including coronary artery stents - for over 15 years. So far, he has used the Impella 2.5 in two patients, both of whom did very well with the procedure. The studies will continue for one to one and a half years.

If you are a candidate for high-risk balloon angioplasty and would like more information about the Protect II clinical trial, or to schedule a consultation, please call (510) 796-0222.

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