The patient has a RCA lesion that resulted in a right ventricular, inferior wall, and inferoseptal wall akinesis. The device is an axial flow pump that was percutaneously inserted into the left ventricle via the aortic valve and is called an Impella device.

The Impella device has been used in the cateterization lab, the ICU, and in the cardiac operating room to provide unloading of the left ventricle by a high speed rotor that can achieve cardiac outputs up to 2.5 l/min (5.0 l/m in the larger device). It provides superior unloading of the left ventricle compared to an IABP (0.5 l/min) however, in one study the Impella device did not result in improved survival compared to an IABP. The Impella and an IABP have been used together for cardiogenic shock. In dogs the Impella provided better pressure-volume loops than ECMO. The Impella device has been used in high risk PCI, high risk CABG, and in the ICU for LV support. While AS remains a relative contraindication, the Impella device has been used in a patient with severe aortic stenosis. The Impella device has been used in post-myocardial infarction VSD to support the left ventricle.

The effect of the Impella, which providing higher cardiac output, is the unloading of the ventricle during diastole. The decreased LVEDD and LVEDP would help improve the microcirculation of the left ventricle and the diastolic wall stress. The coronary blood flow increased by 47% in sheep, whereas the coronary blood flow increased by 13% with an IABP.

The Impella device has been used in patients with right ventricular failure and resulted in a decrease of the CVP.

Complications are infection, bleeding, thrombosis, left ventricular wall rupture, and functional mitral stenosis where the device impinges the mitral valve anterior leaflet motion.

In this case, the Impella device was helping the right ventricle. After the RCA was bypassed and the Impella device was removed, the RV free wall, inferior wall, and inferoseptal wall has worse RWMA compared to preop.

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