Axial Flow Percutaneous Ventricular Assist Devices: Physiology, Procedural Considerations, and Clinical Applications-A State-of-the-Art Review.

162 , 172 , 173 In conclusion, Impella as mechanical support in high-risk PCI is backed by evidence that is not always consistent but shows a favorable trend for better short- and long-term outcomes compared to unprotected procedures or those performed with the assistance of other devices.

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The only ranodmized clinical trial (RCT) comparing the 2 devices is the PROTECT II trial, which showed overlapping safety profiles with an important trend for reduced MACE rate at 90 days and lower hypotensive events in 3-vessel disease. 9 Large subsequent registries offered conflicting results: from the same large database, a nonmatched comparison showed higher rates of death and bleeding in the Impella group, while a propensity-adjusted analysis demonstrated lower rates of mortality, myocardial infarction, and CS with Impella compared to IaoBP. 170 , 171 In contrast to ECMO, which provides full cardiopulmonary support, Impella is less invasive, easier to deploy, and associated with lower complication rates in the CHIP population.

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