World's Tiniest Heart Pump Lowers Surgery Risk

Tiny Impella Heart Pump Lowers Surgery Risk
This heart diagram shows blood returning to the heart through the (blue) atrium and ventricle, which send the depleted blood out to the lungs for fresh oxygen. The refreshed oxygen-rich blood returns to the (red) atrium and ventricle, where the tiny curlicue Impella heart pump is temporarily implanted to help keep blood flowing out through the aorta to the organs and other vital parts of the body.

"Doctors at other hospitals told me for years there wasn't anything else they could do to help my heart. But after I came to the John C. Lincoln in April — because I could hardly breathe — I woke up with something that felt like a new heart.

"And I haven't had any chest pain since then," 65-year-old Phoenix retiree William Armstrong recalled, with a fair amount of satisfaction.

It was, he agreed, a pretty dramatic turnaround.

Armstrong's heart problems started more than a decade ago while he was still active as a painter and contractor working on construction projects throughout the Valley. His heart problems worsened over time, and in 2007 he had triple bypass heart surgery.

"It was a big surgery," he said. It forced him to retire, but it didn't solve all his heart problems. "I've had several angioplasties over the years since. Then doctors told me they'd done all they could."

Because his medical problems left him unable to work or manage his own home, Armstrong moved in with his adult son and was relatively sedentary. When he attempted even moderate activity, he'd have to reach for the nitroglycerin or other heart medications.

In early April, chest pain and breathing problems brought him to the John C. Lincoln Deer Valley Hospital Emergency Department.

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"I can't tell you what they did during the first couple of days I was there," he said. "They had me on a lot of medicine and I just don't remember anything."

His doctor remembers.

When Armstrong came into the Emergency Department, interventional cardiologist Tri Nguyen, MD, medical director of Non-Invasive Cardiology and vice chairman of the Department of Medicine at the Deer Valley Hospital, was on call.

"When we evaluated Mr. Armstrong," Dr. Nguyen said, "we discovered that two of his three bypass grafts had failed, and the one remaining was a very small vessel that could not carry enough blood for his heart to function effectively. That's not good. This explained why he was in such constant pain and why, frankly, the quality of his life was horrible."

Armstrong's severe coronary artery disease, problems with his heart valves and fragile overall health made him an extremely high risk patient, even for a procedure that is usually not considered particularly risky.

"We needed a backup plan in case his heart failed while we were working on him," Dr. Nguyen said. "We needed to be sure his heart would keep working." Armstrong's backup plan was the world's tiniest heart pump, a minimally invasive cardiac assist device called Impella LD that helps the heart pump blood during interventional procedures.

The Impella device is not new; it was approved by FDA in 2008. But within the past six months it has been recommended in medical protocols published by the American College of Cardiology, the American Heart Association and the Society for Cardiac Angiography and Interventions.

Impella is not a permanent fixture. It is a temporary bridge that helps the heart continue to pump and keep blood flowing to the brain and vital organs while patients are treated for severe heart attacks or with high risk angioplasties.

Installed with a catheter through the ascending aorta and into the heart's left ventricle, it reduces the heart's workload while increasing cardiac output. That means it reduces the heart's oxygen consumption while increasing the delivery of oxygen and other vital nutrients, through blood delivery throughout the body.

Dr. Nguyen installed two stents in Armstrong's coronary arteries so that optimal blood flow could resume. The procedure took less than an hour and when the stents were successfully placed, the Impella pump was withdrawn.

"I'm feeling so much better now," Armstrong said. "I'm really glad that Dr. Nguyen could implant the new device without opening my chest. I don't think I could have handled that again."

While recuperating, Armstrong said he's watching a lot of television, except on "really good days when I take my motorcycle, my Harley, out for a ride."

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