10．Impella

Microaxial Flow Pump （Impella）：Clinical Evidence and Guideline

カテーテルに小型軸流ポンプが内装されたImpella（Abiomed社）は低侵襲な補助人工心臓といえるが，2017年に本邦にも導入され現在までに全国263施設で累計14,000例以上に使われている．昨年，DanGer trialによって急性心筋梗塞（AMI）ショックに対する有効性が示され，米国心臓病学会（ACC）/米国心臓協会（AHA）のガイドラインも大きく書き換えられた．本稿ではこのテクノロジーの臨床効果と将来展望について概説する．

The Impella is a catheter-based microaxial flow pump that is inserted through a small vascular graft （Impella 5.5） or directly from femoral artery （Impella CP） and placed across the aortic valve. By draining blood from the left ventricle and pumping it to the ascending aorta, the device not only increases cardiac output, but also unloads the left ventricle which facilitates recovery of damaged cardiac muscles. It has been used in more than 14,000 cardiogenic shock patients in Japan and excellent clinical outcomes have been published in more than 20 major journals in the last three years using J-PVAD registry which is a mandatory national database. New evidences and guidelines may upgrade the value of this device as a less invasive left ventricular unloading device even more in the near future.