Meenakshi Mission Hospital Performs South Tamil Nadu’s First High Risk Angioplasty Assisted by Impella Heart Pump

Madurai, December 24 2020: Meenakshi Mission Hospital and Research Centre - Madurai becomes the first hospital in South Tamil Nadu to perform angioplasty heart surgery assisted by a mechanical heart pump called Impella which takes over the heart’s function during the procedure. 

(L to R) Dr. N. Ganesan, Sr. Consultant- Interventional Cardiology,Meenakshi Misson Hospital and Research Center, Madurai, Patient Yesodha (77)& Dr R. Sivakumar, Senior Consultant - Interventional Cardiology, Meenakshi Misson Hospital and Research Center, Madurai

Known as Protected Percutaneous Coronary Intervention (Protected PCI), the procedure was performed on December 18^th on a 77-year-old lady by a team headed by Dr R. Sivakumar, Senior Consultant - Interventional Cardiology, Meenakshi Misson Hospital and Research Center, Madurai. The patient is fully recovered and is fit to resume her normal life. Impella was removed after the surgery. Both the insertion and removal of the heart pump, the smallest in the world that measures 14 French (Fr) or 4.62 millimeters in diameter upon insertion and removal, was done through the groin artery.

When a angioplasty is performed on a patient whose heart is too weak - owing to factors like over calcification and severe blockage of arteries, even a minimally-invasive heart surgery like angioplasty can overwhelm the heart and make it stop, causing death. But Impella can bring down the mortality rate during the angioplasty from over 25% to less than 5% by helping the heart rest and recover during the surgery by taking over its function temporarily. The pump can do the heart’s function up to 7 days post-surgery, when required. 

In his comments about the new Impella assisted surgery, Dr Guru Shankar, Chairman, Meenakshi Mission Hospital and Research Centre, Madurai said that Impella is considered a boon for patients who have a weak and failing heart, and for whom performing even a minimally-invasive heart surgery like angioplasty can overwhelm the heart and make it stop. With Impella, this risk is reduced significantly. Impella is in use in the US and Europe for a few years but it is approved in India in 2018. Though two surgeries, assisted by Impella, were performed in Tamil Nadu - one in Chennai, and another in Vellore, this is the first time a hospital In South Tamil Nadu performed it. 

In his comments, Dr. R. Sivakumar, said that the patient with known heart disease since 2012 developed a critical block with a thick chunk of calcium in her main coronary artery. With this condition, doing angioplasty without mechanical circulatory support will be a disaster. Hence we opted for Protected PCI with Impella. We inserted this heart pump before angioplasty. We cleared the calcific block using intracoronary lithotripsy. The entire procedure was done under intracoronary imaging. 

Dr.R.Sivakumar said that the traditional method is to use an Intra Aortic Balloon Pump to inflate and deflate when placed in Aorta to help the heart pump more blood out to the body while using less energy. It is a non-motorized pulsatile pump. It will be of no use if the heart stops functioning during high risk angioplasty. 

However, Impella is a Continuous Axial Flow Pump. It is a heart pump that can temporarily assist the pumping function of the heart. Hence Impella makes an invasive or minimally invasive coronary intervention safe, as even when the heart stops functioning, this mechanical device can ensure that blood is pumped out of the heart and provide the critical hemodynamic stability - the state when stable blood flow in the heart and vessels is maintained to support normal functions of all organs. 

Dr.N.Ganesan, Sr.Consultant- Interventional Cardiology, Meenakshi Mission hospital said that acute heart attack complicated by cardiogenic shock (AMI-CS) is associated with in-hospital mortality between 55% -85%. Prior to the advent of percutaneous heart pump, prompt angioplasty with the addition of vasopressors and inotropes (to improve BP) were the standard of care in the management of this critical population which is associated with high mortality of 55%. If the cause of refractory shock is LV failure, escalation of LV support should be considered. Rapid left ventricular hemodynamic support using the Impella pumps improve outcomes and result in survival to device explant of 89% and survival to discharge of 84%. The biggest advantage is safety – we believe this device allows patients to get safely through high-risk procedures, and hospital stay will be shorter and less complicated.

Protected PCI with Impella is becoming a widely accepted stent procedure in patients with a combination of severe coronary artery disease, and other conditions such as diabetes, heart failure, advanced age, complex lesions, rest angina with unstable haemodynamics prior to the high risk angioplasty.

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