The RV Impella is a temporary heart pump designed to provide support to a struggling heart. It functions as a percutaneous right ventricular assist device, meaning it is inserted through the skin and helps the right side of the heart pump blood. This device can provide temporary support for up to 14 days, aiding the heart’s recovery or serving as a bridge to other treatments.
Understanding Right Heart Failure
Right heart failure, also known as right ventricular heart failure, occurs when the heart’s right ventricle cannot effectively pump deoxygenated blood to the lungs. The right ventricle’s role is to receive blood from the body and pump it into the pulmonary arteries, which then carry it to the lungs for oxygenation. When the right ventricle weakens, blood can back up in the veins, leading to increased pressure and fluid accumulation in various parts of the body, such as the legs and abdomen.
Left-sided heart failure is the most common cause of right heart failure, as the backup of blood from the left side can increase pressure in the pulmonary system, putting strain on the right ventricle. Other causes include acute pulmonary conditions like severe pneumonia, acute pulmonary embolism, or acute respiratory distress syndrome (ARDS). When the right ventricle fails to pump efficiently, it can lead to insufficient delivery of oxygen and nutrients to the body’s tissues.
How RV Impella Supports the Heart
The RV Impella device, such as the Impella RP or Impella RP with SmartAssist, operates as a micro-axial flow pump. This device is designed to actively pump blood from the right side of the heart, bypassing the failing right ventricle. The Impella RP is a catheter-based pump.
The device is inserted through a blood vessel, usually in the femoral vein, and advanced across the tricuspid and pulmonic valves. Its inflow section is placed in the right atrium or inferior vena cava, while the outflow section is positioned in the pulmonary artery. This placement allows the pump to draw deoxygenated blood from the right side of the heart and propel it directly into the pulmonary artery, ensuring blood reaches the lungs for oxygenation. The Impella RP can provide a flow rate, reducing the workload on the struggling right ventricle and improving blood flow to the lungs and the rest of the body.
When RV Impella is Utilized
The RV Impella system is indicated for providing temporary right ventricular support in specific medical scenarios where acute right heart failure occurs. One common situation is following left ventricular assist device (LVAD) implantation, where the right ventricle may struggle to keep up with the increased blood flow from the LVAD. It is also used in cases of acute myocardial infarction (heart attack) that lead to right ventricular dysfunction.
Other indications include acute right heart failure or decompensation that develops after heart transplant or open-heart surgery. Its use aims to stabilize hemodynamics and improve patient outcomes in these challenging clinical situations.
The RV Impella Procedure and Recovery
The insertion of the RV Impella device is a percutaneous procedure, meaning it is done through the skin without large incisions. A large blood vessel, most commonly the femoral vein in the groin, is accessed to insert the catheter. Fluoroscopy, a type of real-time X-ray imaging, is used to guide the precise placement of the device within the heart, ensuring the inflow is in the right atrium or inferior vena cava and the outflow is in the pulmonary artery.
Following insertion, the patient is monitored in an intensive care unit (ICU) to manage their condition and the device’s function. The duration of Impella support can vary but is approved for up to 14 days. As the right ventricle recovers, the medical team will gradually reduce the device’s support, a process known as weaning, until the heart can adequately pump on its own.