Table 2.
Comparison of Technical and Clinical Features of Contemporary Percutaneous Mechanical Circulatory Support Devices.
| Features | IABP | Impella 2.5 | Impella CP | iVAC 2L | TandemHeart | VA-ECMO |
|---|---|---|---|---|---|---|
| Inflow/outflow | Aorta | LV→aorta | LV→aorta | LV→aorta | LA→aorta | RA→aorta |
| Mechanism of action | Pneumatic | Axial flow | Axial flow | Pulsatile flow | Centrifugal flow | Centrifugal flow |
| Insertion approach | Pc (FA) | Pc (FA) | Pc (FA) | Pc (FA) | Pc (FA/FV) | Pc (FA/FV) |
| Sheath size | 7–8 F | 13 F | 14 F | 17 F | Venous: 21 F Arterial: 12–19 F | Venous: 17–21 F Arterial: 16–19 F |
| Flow (L/min) | 0.3–0.5 | Max 2.5 | 3.7–4.0 | Max 2.8 | Max 4.0 | Max 7.0 |
| Pump speed (RPM) | N/A | Max 51,000 | Max 51,000 | 40 mL/beat | Max 7500 | Max 5000 |
| Duration of support | 2–5 days | 6 h–10 days | 6 h–10 days | 6 h–10 days | UP to 14 days | 7–10 days |
| LV function dependency | + | − | − | − | − | − |
| Synchrony with the cardiac cycle | + | − | − | − | − | − |
| LV unloading | + | ++ | +++ | + | +++ | − |
| Afterload | ↓ | ↓ | ↓ | ↓ | ↑ | ↑↑ |
| MAP | ↑ | ↑↑ | ↑↑ | ↑↑ | ↑↑ | ↑↑ |
| Cardiac index | ↑ | ↑↑ | ↑↑↑ | ↑↑ | ↑↑↑ | ↑↑↑ |
| PCWP | ↓ | ↓ | ↓↓ | ↓ | ↓↓ | ↔ |
| LVEDP | ↓ | ↓↓ | ↓↓ | ↓↓ | ↓↓↓ | ↔ |
| Coronary perfusion | ↑ | ↑ | ↑ | ↑ | ↔ | ↔ |
| Myocardial oxygen demand | ↓ | ↓↓ | ↓↓ | ↓↓ | ↓↔ | ↔ |
| Anticoagulation | + | + | + | + | + | + |
| Implant complexity | + | ++ | ++ | ++ | +++ | ++ |
| Management complexity | + | ++ | ++ | ++ | +++ | +++ |
| Complications | Limb ischemia, bleeding | Hemolysis, limb ischemia, bleeding | Hemolysis, limb ischemia, bleeding | Hemolysis, limb ischemia, bleeding | Limb ischemia, bleeding, hemolysis | Bleeding, limb ischemia, hemolysis |
| Contraindications | Moderate-to-severe AR, severe PAD | Severe AS/AR, mechanical AoV, LV thrombus, CI to AC | Severe AS/AR, mechanical AoV, LV thrombus, CI to AC | Severe AS/AR, mechanical AoV, LV thrombus, CI to AC | Moderate-to-severe AR, severe PAD, CI to AC, LA thrombus | Moderate-to-severe AR, severe PAD, CI to AC |
| CE-certification | + | + | + | + | + | + |
| FDA approval | + | + | + | − | + | + |
Abbreviations: AC, anticoagulation; AoV, aortic valve; AR, aortic regurgitation; AS, aortic stenosis; CI, contraindication; FA, femoral artery; FDA, US Food and Drug Administration; FV, femoral vein; LV, left ventricle; LVEDP, left ventricular end-diastolic pressure; IABP, intraaortic balloon pump; MAP, mean arterial pressure; Max, maximum; PAD, peripheral arterial disease; Pc, percutaneous; PCWP, pulmonary capillary wedge pressure; PS, peripheral surgical; RA, right atrium; RPM, rotations per minute; VA-ECMO, venoarterial extracorporeal membrane oxygenation.