Impella 5 5 with SmartAssist

Welcome to “Heart to Heart:” a podcast about all things heart-related presented by the physicians of Advanced Cardiovascular Specialists. I’m your host: Susan Curtin. Our goal is to meet you where you are with valuable information from trusted experts in the field of cardiology.

Today, we’re joined by Dr. Trey Baucum and his patient Richard Feinberg to discuss the Impella 5.5 with SmartAssist. It is a temporary mechanical heart pump used to support patients experiencing severe heart failure or cardiogenic shock.

Richard is a retired attorney who practiced law for 43 years, including 13 years with the District Attorney’s Office in the appellate division. He is married with four children and nine grandchildren. He enjoys spending time with his family, walking his Dalmatian, reading and going to the gym four times a week. He is also considering taking up bicycling again.

Richard’s heart attack began unexpectedly with what felt like severe indigestion. After over-the-counter medications failed to relieve his symptoms, he realized he was likely having a heart attack. His wife immediately drove him to CHRISTUS Highland where testing confirmed that he was experiencing a “widowmaker” heart attack. He was taken to the cardiac catheterization lab where he met Dr. Baucum.

Although many people associate heart attacks with crushing chest pain, Richard primarily remembers the overwhelming indigestion. Medical records also documented chest pain, arm pain and jaw pain. The indigestion was the symptom that stood out most to him.

By the time Dr. Baucum evaluated him, Richard had developed cardiogenic shock. That means his heart was no longer pumping enough blood to sustain his body. His heart rate had fallen to approximately 20 beats per minute, and his blood pressure was dangerously low. His organs were beginning to lose adequate blood flow.

Recognizing that Richard would not survive without immediate intervention, Dr. Baucum implanted an Impella device. The Impella is a temporary mechanical heart pump inserted through an artery in the leg. It sits partially inside the heart and partially within the aorta where it pumps blood from the heart into the body’s circulation. Despite its small size, it can generate enough cardiac output to support a patient even when the heart is barely functioning.

A temporary pacemaker was also placed to increase Richard’s heart rate. As soon as the Impella was activated, Dr. Baucum noticed an improvement. Richard became more comfortable and relaxed. He was even able to rest while the device reduced the workload on his heart.

Additional imaging revealed severe multivessel coronary artery disease. One artery responsible for the heart attack was treated immediately, but the remaining blockages required coronary artery bypass surgery. The Impella allowed Richard’s heart to rest for several days until he was stable enough to undergo quadruple bypass surgery. After surgery, the device was removed.

Dr. Baucum explained that the Impella is typically used only one or two times each month, most commonly during cardiogenic shock or other extremely high-risk situations. It may also be used during particularly complex angioplasty and stenting procedures when the heart needs temporary mechanical support. Compared with older devices such as an intra-aortic balloon pump, the Impella provides significantly greater circulatory support because it can generate cardiac output independently of the heart’s pumping ability.

Following surgery, Richard spent time in intensive care before completing cardiac rehabilitation. His rehabilitation team taught him how to exercise safely, read nutrition labels, reduce sodium intake, and make heart-healthy lifestyle choices.

Today, Richard enjoys retirement, spends time with his grandchildren, walks regularly, goes to the gym, reads, and looks forward to getting back on a bicycle. He credits Dr. Baucum, the surgical team, the intensive care staff, the cardiac rehabilitation team and the availability of the Impella technology with saving his life.

Dr. Baucum noted that if this cardiac event had occurred a few years earlier before the Impella was widely available, Richard’s outcome likely would have been very different. The technology has become a significant advancement in treating patients with severe heart attacks complicated by cardiogenic shock. The device has dramatically improved survival for patients in these critical situations.