A miniature pump, so small it can be threaded through an artery and placed inside the heart, offers new hope to critically ill heart attack and heart failure patients who have run out of options.
The Abiomed Impella 2.5, is making its Tampa Bay area debut at the Pepin Heart Hospital at University Community Hospital. It is a new type of pump that assists the heart's main pumping chamber to drive blood through the body. While it is 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.
Dr. Reynaldo Mulingtapang, an interventional cardiologist with the Pepin Heart Hospital, says heart attack and heart failure patients with blockages need increased blood flow quickly, and the Impella helps provide that. He has placed the device in three bay area patients since February.
John Zweil of Zephyrhills became the third recipient one week ago today, when the 54-year-old man was rushed to Florida Hospital near his home in congestive heart failure and shock. His heart was pumping at just 20 percent of its normal capacity.
"He was already considered dead," says Mulingtapang, "He was barely alive on a small hair string of blood flow to his main artery to his heart."
Zweil, a retired pipe fitter from New Jersey, had suffered a heart attack, and doctors determined he needed immediate open-heart bypass surgery. But, because of his overall poor health and complicated medical history, Zweil was told he was not likely to survive the procedure. Generally, when heart function drops below 30 percent, patients die on the operating room table, Mulingtapang said.
The Florida Hospital team knew the Impella was available just a short drive away, and offered to transfer Zweil to Pepin as a last-ditch effort to save his life.
"I knew I was checking out," said Zweil, who went home on Thursday. "I signed all the papers and agreed to" get the Impella inserted.
Once at Pepin, Zweil was taken to the cardiac catheterization lab where Mulingtapang and his team went to work, first bringing Zweil's erratic heartbeat under control. Then, working through a small puncture in Zweil's leg, Mulingtapang snaked a catheter about the diameter of a couple of strands of spaghetti through the femoral artery and up to the left ventricle or main pumping chamber of the heart.
Imbedded in that small catheter was the half-inch-long Impella, a rotary pump powered by a tiny motor. Once activated by the medical team, the Impella gave Zweil's heart the help it needed to pump blood, increasing his blood pressure to a safe level.
That allowed Mulingtapang to proceed with the next treatment, opening the left main artery and two other blocked arteries, and placing stents to keep them open. Without the Impella procedure, Mulingtapang says Zweil would have been dead in a matter of hours.
Other left-ventricular heart-assist pumps are on the market, but most require open-chest surgery to be implanted - not an option in cases like Zweil's. One device, the intra-aortic balloon pump, has been in use since the 1950s. It, too, can be inserted through a catheter. But it increases blood flow only to about a half a liter per minute; the Impella increases it five times as much.
Dr. Debbie Rinde Hoffman, medical director of cardiac transplantation at Tampa General Hospital, hopes to begin offering her patients the Impella soon. She considers it a big improvement over the standard balloon pump. "It's a nice addition ... especially for patients who we have nothing else to offer." Rinde Hoffman says the Impella also can be used in patients who need heart transplants.
According to the American Heart Association, 610,000 Americans will have heart attacks this year. Abiomed estimates that more than 100,000 will be given the standard balloon pump and could be candidates for the Impella.
Patients can remain on the Impella for several hours or several days. Zweil was supported by the device for 20 hours. When it was removed, he said, "You feel like you're reborn ... like I'm 25."
Now it's Zweil's job to keep his heart healthy, first, by quitting his 25-year, three-pack-a-day cigarette habit.
"Camels. Unfiltered," he says. "I'm done smoking."
Irene Maher can be reached at firstname.lastname@example.org or (813) 226-3416.
It's a lifesaver
-Ten medical centers in Florida have the Impella, including the University of Miami, Orlando Regional Medical Center and Pepin Heart Hospital at UCH in Tampa.
-150 centers nationwide have used the device in more than 300 patients.
-It was approved by the FDA in June 2008.
-Has been used in Europe for six years.