Could provide hope for treatment to numerous patients who are in cardiogenic shock after heart attack or have to undergo high risk angioplasties or surgery because of weak hearts
Fortis Escorts Heart Institute, Centre of Excellence in Cardiac Care, achieved yet another milestone of success when a team led by Dr Ashok Seth, Chairman, Cardiovascular Sciences, performed the India’s first “Protected Angioplasty and stenting procedure”on Tuesday, 26th June 2018 on a patient suffering from life threatening blockages with the support of Impella heart pump. The hospital is the first in India to offer this new life saving treatment to patients suffering from high risk blockages and failing heart – who are at a high risk for surgery and often left with no options. This marks the beginning of the first “Heart Recovery Program” in India, where the device can help the patient’s own diseased and weak heart to rest, recover and function on its own.
The new ‘Impella Device’ is the ‘world’s smallest heart pump’, which can support a failing heart for upto 7-days and occasionally longer. The Impella Device is like a catheter and works on the principle of submersible water pump; it is a thick as a pencil and approx. 6 inches long. Unlike other devices (which are large and need a surgery to implant) the Imeplla can be inserted into the heart without an operation percutaneously through the groin artery in the Cath Lab; it can provide blood flows of 2.5 – 3.5 liters/min. Impella heart pump is used to help maintain stable heart function and to help ensure blood flow is maintained to critical organs such as the brain and kidneys in cases of cardiogenic shock or during high risk angioplasties or surgeries. Once in position, the Impella heart pump withdraws blood from the left ventricle and expels it in to the ascending aorta, the same effect that happens with the pumping motion of your heart. The Impella can support failing heart (cardiogenic shock) due to heart attack or myocarditis for upto 7-days or even longer till heart recovery occurs. It can also be used to support the heart in cases of high risk angioplasties (Protected PCI) in patients with poor heart function and where surgery is considered too risky. It has been proven to support the heart to improve safety of the procedure and improve outcomes. When the procedure is over or the heart recovery occurs, the device can just be pulled out and removed as it is like a catheter. It is approved in and has been used in USA and Europe for the last few years and has been introduced into India now.
The device was used for the first time on Tuesday, 26th June 2018 to treat an 86-year old gentleman who was admitted to Fortis Escorts Heart Institute with severe recurrent chest pains over a week and impending heart attack. An angiogram revealed all his arteries were more than 90% blocked with very hard, calcium deposited life threatening blockages. He had prohibitive risk for surgery so angioplasty was performed as a lifesaving procedure under the support of Impella heart support. The patient had Rotablator drilling performed on all three arteries to remove the calcium followed by implantation of five stents in a procedure lasting for 2½ hours. The heart was supported throughout on the Impella pump to maintain stable pressure and perfusion to brain and kidneys. The patient remained conscious, stable and complication free throughout the procedure. The patient continued the recovery and was transferred to the CCU and was gradually weaned off the pump, which was removed after 5-hours. After the patient stabilized and was in CCU, the Impella pump was removed after 5-hours. The 86-year old gentleman is now well and walking around two days later.
Dr Ashok Seth also added: The device supported the heart admirably to keep the patient stable throughout the very complex angioplasty procedure and afterwards for recovery. It was an extreme high risk angioplasty which was successfully performed without any com0plcaitons with good supply of blood being maintained to the kidneys and brain.
It would have not been impossible to do the procedure with safety without the support of Impella device. This landmark is the start of the first “Heart Recovery Program” in the country where patient with weak hearts and cardiogenic shock can be supported at angioplasty or in CCU to allow heart to recover by implanting a miniatured catheter based heart pump, without surgery. The device can also be used to transport patient in shock to tertiary centres where advanced treatment can be instituted to help survival.
The ‘Heart Recovery Programme’ entails the concept of supporting the failing heart through a period with a heart support device to allow it to recover and function on its own ultimately. If the patient’s own heart recovers and functions well then not only is it the ideal option for the patient for his quality and longevity of life but also has the potential to save healthcare costs. It differs from other left ventricular assist devices, which are mainly artificial hearts, are a bridge to transplantation, expensive and involve major surgical procedure for implantation. The Impella Heart Support pump can support the heart function and give rest to the heart in cases of cardiogenic shock after heart attack, myocarditis, post cardiotomy till heart can recover by drugs or through supported angioplasty. In patients with multiple blockages and/or depressed heart function, who are high risk for surgery, protected angioplasty and complete revascularization of multiple blockages with the support of Impella can help recovery of heart function and improve survival.
Presently, the only other device to temporarily support the heart over Intra-Aortic Balloon pump, which is not very effective in severe shock and has not been proven to improve survival and ECMO, which is no physiological, extremely cumbersome to implant and has its own risk as it function like a bypass.