Axillary Access, Cardiomyopathy, AMI Cardiogenic Shock, Surgical Applications
Impressive Survival and Heart Recovery in Cardiogenic Shock with Impella 5.5® with SmartAssist®
Danny Ramzy, MD discusses his experience with the Impella 5.5® heart pump and his recently published paper, “New Surgical Circulatory Support System Outcomes.” This paper reports the first U.S. experience with Impella 5.5 for treatment of ongoing cardiogenic shock following AMI (AMICS), postcardiotomy cardiogenic shock, and cardiomyopathy including myocarditis. Dr. Ramzy is the director of robotic & minimally invasive cardiac surgery at Cedar Sinai Medical Center in Los Angeles.
“What you see now with this manuscript is that survival is quite impressive for this type of patient,” Dr. Ramzy states, referring to the results of the paper demonstrating that 83.6% of patients survived to explant with 76.1% of these patients recovering native heart function. In his experience with Impella 5.5, Dr. Ramzy notes, “We really see a significant increase in the use in postcardiotomy shock and an increase in use in AMI shock with tremendous improvement in survival compared to the historic controls.”
Dr. Ramzy highlights ease of implantation and ease of repositioning as key advantages to using Impella 5.5. He also emphasizes the importance of the Impella Connect® system and SmartAssist® technology, especially for a shock team approach, developing algorithms, and for bridge to decision (BTD), recovery and weaning. “I think it’s really good for bridge to device or bridge to recovery, where you want to leave it a longer period of time,” Dr Ramzy tells interviewer Tom Vassiliades, MD. “It’s very striking for this patient population to have this kind of outcomes.”
Dr. Ramzy describes how outcome is driven by the shock team approach at his institution, and the importance of SmartAssist information for heart recovery and weaning. “I really see, in the short period of time, having SmartAssist-driven algorithms in terms of weaning these patients. We’re not there yet, but it’s really a tool that a lot of the unit and cardiologists really like.” He also describes the Impella 5.5. as a good hemodynamic support option when the balloon pump is not enough and ECMO may be too much. “It’s really changed how we manage post-pump shock.”
Dr. Ramzy provides a few tips and tricks regarding axillary access, explaining, “It’s an approach that more and more surgeons are getting familiar with… it’s not that daunting. You just have to do it.” He envisions broader use of the Impella 5.5, not only in large transplant centers but in smaller centers. “In shock and in AMI shock, I think that is sort of the biggest advantage with the 5.5. It’s going to be able to be placed in more places and benefit more patients.”
Dr. Ramzy also discusses the potential for managing stable, ambulating patients supported with Impella 5.5 in the step-down unit with Impella Connect remote monitoring in today’s COVID-19 environment to free up ICU space as well as save cost. In addition, he emphasizes that today many cases that wouldn’t have been done or would likely not have had successful outcomes are being planned with the use of Impella. “This is a large group of patients that never got operated on. And now they’re getting surgeries.”