Though it’s the smallest of its kind, the Impella device is a powerhouse when an ailing heart needs help pumping.
“It’s like a little jet engine for the heart,” says Dr. Michael Sabbah, a board-certified interventional and structural cardiologist at Jupiter Medical Center. “It pushes blood to the body if the heart is too sick to do it.”
The Impella device comes in three platforms, each designed for a slightly different condition. In each case, however, it pushes blood out to the vital organs when the heart cannot manage on its own, a condition called cardiogenic shock.
That allows the heart to rest and recover while the Impella device keeps the blood and oxygen moving. According to Abiomed, the device’s manufacturer, a randomized, controlled trial found that 8 in 10 patients treated with Impella devices experienced a reduction in heart failure symptoms or improvement in heart function.
“There are different stages of cardiogenic shock,” Sabbah says, “We do know that if you intervene earlier, patients do better than if we wait until they get sicker.”
Cardiovascular disease is the No. 1 killer of American adults. Roughly 6.7 million people over age 20 had some degree of heart failure in 2024, according to the American Heart Association. That figure is expected to rise steadily—by 2050, an estimated 11.4 million people are expected to have it. That means 25 percent of the adult population—one in every four people—will develop heart failure.
“The heart can be weakened from some sort of illness, a heart attack, prior heart attacks, a virus, or other issues,” Sabbah says. “When the heart-pumping function is reduced, the Impella device is a great tool to save lives, although not the only one that physicians use to treat these conditions.”
Cardiogenic shock is the most severe form of heart failure. According to the National Institutes of Health, it “happens when your heart cannot pump enough blood and oxygen to the brain and other vital organs. This is a life-threatening emergency. It is treatable if diagnosed right away, so it’s important to know the warning signs.”
Cardiogenic shock can strike suddenly, causing dizziness; severe shortness of breath; chest pain; low blood pressure; sweating; pale, clammy skin; reduced urine output; accelerated heart rate; nausea; vomiting; edema (swelling); and bulging neck veins. The condition can cause damage to the heart, liver, kidneys, and other vital organs if they are deprived of blood for too long.
Sabbah says that when a patient is diagnosed with cardiogenic shock and needs swift treatment, members of the heart team gather swiftly to determine the best course of action. “It’s a multidisciplinary approach involving the heart team,” Sabbah says. “What are the best individualized therapeutic treatments? Do they need surgery, a stent, and/or medication? For those patients who get Impella, it acts as a bridge. It allows us to administer other lifesaving therapies, such as medicines and additional procedures, keeping the patient as safe as possible while we do so,” Sabbah says.
Depending on factors such as a patient’s age and overall health, the heart team discusses whether the patient can withstand surgery or if a less invasive procedure is advisable. The Impella device might be included if the patient has heart failure, cardiogenic shock, or is undergoing a high-risk cardiac procedure.
The Impella device isn’t a solution unto itself; it allows the medical team to provide treatment. Doctors first insert the Impella device into a blood vessel through the groin, similar to what is done during cardiac catheterization. The thin catheter is sent up the blood vessel into the left ventricle of the heart under X-ray guidance, where it can take the place of the ailing heart muscle while doctors perform procedures or administer medications to help the heart pump as best as possible.
“We use the Impella a lot in the cath lab when patients have a high-risk stenting procedure (to open blockages in blood vessels),” Sabbah says. “If the patient is not able to undergo heart surgery the traditional way, perhaps due to age or comorbidities, we have the ability to offer these patients a type of minimally invasive procedure” that may require placement of an Impella “to keep the patient safe when undergoing a higher-risk procedure when we don’t have any other options,” he says.
The Impella device consists of a small, motorized pump with an attached catheter that is usually inserted through the femoral artery then guided into the heart’s left ventricle. Once it’s in place, it does the blood-pumping work of the left ventricle. This makes it minimally invasive, reducing the need for open-heart surgery.
Use of the device is temporary. “Often if somebody has a heart attack, it can stun the heart. It may be getting blood, but because of the heart attack, it can lose the ability to squeeze temporarily,” Sabbah explains. “The Impella device buys us time to allow the good muscle to recover until the device is no longer needed.” He says it can also be used during surgery, placed at the end of the procedure to allow the heart time to recover. Although there aren’t specific guidelines as to how long an Impella device should remain in place, they are used for hours to days, “but usually a week or less,” Sabbah says.
There are three kinds of Impella devices:
Impella CP (Cardiac Power): Offers up to 4 liters per minute of blood flow and is often used in patients with cardiogenic shock or acute myocardial infarction. These can be placed quickly in the catheterization laboratory for a patient who is unstable and needs quick intervention.
Impella 5.5: Delivers up to 5 and 5.5 liters per minute of blood flow, respectively, when more substantial support is necessary. Performed in the operating room by a surgeon.
Impella RP (Right Peripheral): Designed specifically to support the right side of the heart by providing up to 4 liters per minute of blood flow. While the left ventricle pumps blood to the body, the right ventricle sends it to the lungs. When that system is impacted by a heart attack, the Impella RP can assist pumping on the right side while the Impella CP can help on the left side.
The device—in use in the United States since 2008—is not recommended for people with a mechanical aortic valve, aortic insufficiency, severe peripheral artery disease, or an ascending aortic aneurysm, among other conditions. And, like all medications and treatments, there are some risks, including bleeding, left ventricle perforation, stroke, device failure, infection, hemolysis, hypertension, and lack of blood flow.
Nonetheless, the device has the potential to keep a heart beating and organs operating smoothly until a cardiac crisis is over. “I like to think of Impella as a great tool to have in the toolbox,” Sabbah says. “It’s not necessarily the No. 1 tool you pull out, but I take comfort knowing that it’s available for our patients. For the sickest patients, you still have an ace up your sleeve. You have something that can still help them.”
BY THE NUMBERS
(Source: U.S. Centers for Disease Control and Prevention)