Angioplasty Assist

September 20, 2006 Coronary artery disease is a condition in which the inner walls of the hearts arteries become narrowed by an accumulation of plaque. Over time, as more plaque accumulates, the channel for blood flow narrows. Some parts of the heart muscle may not get enough oxygen, leading to a type of chest pain, called angina. Eventually, the plaque can build up enough to completely block the flow of blood. More commonly, some of the plaque breaks loose. The body senses this as an injury and forms clots to "heal" the area. The clots can also block the flow of blood. In either case, the area of heart muscle fed by the part of the artery beyond the point of blockage is deprived of oxygen and dies. This is known as a heart attack, or myocardial infarction. Heart disease is the leading cause of death in the U.S. The American Heart Association estimates 1.2 million men and women will have a heart attack this year. In 2003, heart attacks killed 221,000 Americans. Of those who survive, 25 percent of men and 38 percent of women will die within one year. Within six years of a heart attack, 18 percent of men and 35 percent of women will die. Treating Heart Disease: Angioplasty When one or more coronary arteries are significantly blocked, doctors may perform a procedure, called angioplasty, to open up the narrowed vessel. A small cut is made into a blood vessel in the area of the groin. Then, using X-rays for guidance, a catheter is slowly fed through the circulatory system to an area of blockage in the heart. Once in place, a balloon at the tip of the catheter is slowly inflated. As the balloon expands, it pushes the plaque, compressing it against the wall of the artery and opening the passageway. Sometimes an expandable, hollow metal tube, called a stent, is inserted to hold the plaque against the arterial wall and keep the vessel open. According to the American Heart Association, about 1,244,000 angioplasties were performed in the U.S. in 2003. The procedure can be highly effective in reducing the risk of a heart attack. Angioplasty is also less invasive than coronary artery bypass surgery (using an artery from elsewhere in the body to re-route blood flow around the area of blockage). Help for High-Risk Angioplasty Patients For some patients, angioplasty may be a safer alternative than bypass surgery. However, there are some people for whom even angioplasty is a risky procedure. Patients with severe left ventricular function (strength of the main pumping chamber of the heart) and those with many blocked coronary arteries are often seen as too high risk to undergo angioplasty. Thats because during angioplasty, blood flow to the heart may be severely compromised, leading to a sudden drop in blood pressure, heart failure, shock or unexpected heart attack. Researchers at William Beaumont Hospital in Detroit, Michigan are testing a new device for high-risk angioplasty patients, called the IMPELLA® 2.5. Its a miniature heart pump so small it can be inserted into the artery through a catheter. During angioplasty, the tiny pump keeps blood flowing through the left ventricle and into the aorta, where it can circulate to the rest of the body. The IMPELLA can pump up to 6 liters of blood per minute. By maintaining circulation, there is less risk of reduced blood flow, shock or other complications. Currently, the IMPELLA is in a pilot study in the U.S. The first patient received the device at William Beaumont Hospital in July. Other U.S. study sites include: Scripps Clinic, La Jolla, CA Cedars-Sinai Medical Center, Los Angeles, CA Brigham & Womens Hospital, Boston, MA Columbia Presbyterian, New York, NY Texas Heart Institute, Houston, TX AUDIENCE INQUIRY For information about the Impella 2.5, visit the companys website at http://www.abiomed.com, or http://www.impella.com/start_en.htm For general information on coronary artery disease or angioplasty: American Heart Association, http://www.americanheart.org, or contact your local chapter National Heart, Lung and Blood Institute, http://www.nhlbi.nih.gov BIBLIOGRAPHY "Atherosclerosis," Bethesda: National Heart, Lung and Blood Institute, downloaded from website (http://www.nhlbi.nih.gov), August 16, 2006. "Coronary Artery Disease," Bethesda: National Heart, Lung and Blood Institute, downloaded from website (http://www.nhlbi.nih.gov), August 16, 2006. "Heart Disease and Stroke Statistics - 2006 Update," Dallas: American Heart Association, 2006. Henriques, Jose, M.D., Ph.D., "Safety and Feasibility of Elective High-Risk Percutaneous Coronary Intervention Procedures with Left Ventricular Support of the Impella Recover LP 2.5," American Journal of Cardiology, April 1, 2006, Vol. 97, No. 7, pp. 990-992. Jurmann, M., et al., "Initial Experience with Miniature Axial Flow Ventricular Assist Devices for Postcardiotomy Heart Failure," Annals of Thoracic Surgery, May 2004, Vol. 77, No. 5, pp. 1642-1647. Kar, Biswajit, M.D., et al., "Hemodynamic Support with a Percutaneous Left Ventricular Assist Device," Texas Heart Institute Journal, 2004, Vol. 31. No. 1, pp. 84-86. Meyns, B., "Coronary Artery Bypass Grafting Supported with Intracardiac Microaxial Pumps versus Normothermic Cardiopulmonary Bypass," European Journal of Cardiothoracic Surgery, July 2002, Vol. 22, No. 1, pp. 112-117. Ramondo, A., et al., "High-risk Percutaneous Coronary Intervention Using the Intracardiac Microaxial Pump ‘Impella Recover," Journal of Cardiovascular Medicine, February 2006, Vol. 7, No. 2, pp. 149-152. Siegenhaler, M., et a., "The Impella Recover Microaxial Assist Device Reduces Mortality for Postcardiotomy Failure," Journal of Thoracic and Cardiovascular Surgery, March 2004, Vol. 127, No. 3, pp. 812-822. Zavala-Alarcon, Edgardo, M.D., et al., "Safety of Elective - Including ‘High Risk" - Percutaneous Coronary Interventions Without On-Site Cardiac Surgery," American Heart Journal, October 2004, Vol. 148, No. 4, pp. 676-683. Research compiled and edited by Barbara J. Fister