Published on March 05, 2009

Helping High-Risk Heart Patients

First- in-the-region heart pump boosts cardiac output by 50 percent 

At many other heart centers, 76-year-old Alice White of DeWitt might have been out of luck.

The three major arteries of her heart had challenging blockages, including one that was beyond repair. Along with her other health issues, her weak heart made the risks of coronary artery bypass surgery or balloon angioplasty excessively high.

"It was scary," says her daughter, Melissa Lane of DeWitt. "She was very short of breath and having chest pains. Her heart was working at a very low percent. We knew angioplasty was too risky but had held out hope that bypass surgery would make her better. When we learned the heart surgeons didn't think she could survive bypass surgery, we worried."

Alice White was fortunate that a breakthrough technology had arrived at Genesis Medical Center, Davenport just one month before. A tiny heart pump would bolster her own heart while cardiologist Nicolas Shammas, M.D., performed a lifesaving intervention.

The Abiomed's Impella 2.5 circulatory support system centers on a tiny pump that is inserted into weak hearts to help them function. The pump augments the heart's pumping action and provides precious time for doctors to make repairs, such as balloon angioplasty or stent placement, on critically ill cardiac patients.

Genesis is the first in the region to have the technology and was the first to use it in Iowa.high risk

"She was a perfect candidate for the Impella," says Dr. Shammas of Cardiovascular Medicine, P.C. "Her ejection fraction, or the heart's pumping power, measured about 15 percent -- a very high-risk situation. Three out of three of the major arteries of the heart were severely blocked. One couldn't be repaired. Of the remaining two, one was 95 percent blocked and the other was 80 percent blocked over multiple segments.

"With her heart function being only 15 percent, if anything went wrong with any arteries during treatment, her blood pressure would go completely down, and she would be unable to sustain life."

Pumping power

The Impella can pump approximately 2.5 liters of blood per minute to boost the heart's pumping power, providing the safety net Alice White needed. The device is so small, only 6.4 mm in diameter, it can be inserted into a patient's heart through a small catheter placed through the femoral artery in the leg to the heart's left ventricle and into the ascending aorta. The procedure takes place in the Cardiac Catheterization Lab.

"The Impella allows us to go places where we don't normally go in treating coronary arteries," Dr. Shammas explains. "The majority of interventionalists will shy away from treating such high-risk cases. Now with the Impella, we have this safety net. We can boldly go where interventionalists have not gone before."

Cardiologist Nicolas Shammas, M.D. uses the Abiomed Impella 2.5 heart pump whilea high-risk patient undergoes angioplasty and stent placement. Jena Moore, RTR, assists him.

Dr. Shammas adds, "The device enabled us to literally do a case that normally we would have avoided. This patient would have had no other choices, and her life expectancy would have been markedly reduced."

The cardiac output of a normal heart is 5 liters per minute. The Impella gave Alice White's low-pumping heart an additional 50 percent -- or 2.5 liters of blood per minute. This enabled her blood pressure to remain stable during the procedure, despite five stents being placed in two different portions of the heart. "Once the stents were in, we lowered the performance of the temporary device over 15-20 minutes, and she sustained a very nice blood pressure," Dr. Shammas says. "Then we removed it."

Over the next three to four months, the hope is that White's heart function will improve. "The heart muscle is like a bear in hibernates to some extent when there isn't enough blood supply going to the heart. The heart gets lazy and weakens," Dr. Shammas explains. "With the blood supply back, the hope is the muscle isn't scarred and that it will improve. If the ejection fraction remains below 35 percent, she's still at risk. In this situation, we ask our electrophysiologists to place an internal defibrillator to protect the heart from sudden arrhythmias."

For years, cardiologists have used other support devices to support blood pressure and heart function, including the intra-aortic balloon pump. The Impella 2.5 provides the heart with active support five times faster than current industry devices and 3-5 times more blood flow than the current standard of care, company officials say.

"This device takes literally only 5 minutes to place in the patient, and it can make a big difference in a person's life," Dr. Shammas says.

Just hours after last week's procedure, Melissa Lane was ecstatic to see her mother already feeling better. "When she came back to the floor, she opened her eyes, smiled and said everyone at Genesis was wonderful."

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