The University Health system became the first institution in Virginia to insert a temporary heart pump — an Impella — into a patient that is under 18. The procedure was completed by Dr. Michael McCulloch, medical director of the Pediatric Pulmonary Hypertension and Mechanical Circulatory Support Programs and associate professor of pediatrics, and his team Aug. 10.
According to the National Institutes of Health, the Impella device is a miniature catheter-based device, in which a long tube is “placed in the left ventricle across the aortic valve" to pump blood and maintain a systemic circulation. Although the device was originally intended to treat adults when it was invented by Dr. Thorsten Siess, Ph.D., in 1997, the device is also beneficial if used properly in patients under 18, according to McCulloch.
“The pediatric world is left to contend with using devices that were originally designed for adults but making them work for pediatrics.” McCulloch said in an interview with The Cavalier Daily.
According to McCulloch, another level of “complication” when treating children who need heart transplants is the scar tissue they may have developed over time from multiple surgeries. McCulloch explained how children who have heart failure and undergo multiple heart surgeries will typically have scar tissue as a result of the midline sternal incision that doctors perform on the center of the chest.
“So getting in there the next time becomes more complicated and more dangerous,” McCulloch said. “And that includes placing one of these machines that are called ventricular assist devices.”
According to Mayo Clinic, a ventricular assist device helps pump blood from either of the two lower chambers in the heart to the rest of the body. The VAD is typically used to treat a weakened heart or heart failure and may also be used in a patient if they are waiting for a heart transplant. The Impella pump is classified as a ventricular assist device.
McCulloch explained that with the Impella device, doctors do not need to open the front of the chest to put the device in patients. The device is inserted through a small incision at the top of the chest and then it is inserted into a blood vessel that goes in the arm. From there, the tube traverses to the left side of the heart of the patient, which is the side that pumps blood out to the body, according to McCulloch.
“You turn the pump on, and … [it] rotates at really high RPMs and it pulls the blood from the heart, and pushes it out into the aorta," McCulloch said. “So this pump, especially for [the] pediatric population, the volume of flow it can produce is typically enough to support the entire body on its own.”
Although used in a patient under 18, pediatric patients still must meet certain metrics to be eligible to receive the Impella pump. McCulloch explained how the pump is an option for children who are tall enough due to the length of the tube. According to McCulloch, a patient must have specific dimensions for both their heart and blood vessels in order for the catheter to be placed inside of them.
Since the Impella pump was originally intended for adults, the device may not be used on small patients, including newborn children.
When asked about the future and longevity of this Impella pump in pediatrics, McCulloch said he believes the University is likely one of the only medical centers in the Commonwealth where this procedure will be performed due to the more advanced technologies needed.
“I think we will likely be the only pediatric cardiac program to do this, because we’re the only pediatric heart transplant program in the state,” McCulloch said. “It’s not common to put [these devices] in if you were not moving towards a transplant, for most scenarios.”
McCulloch explained that the success of this procedure is due to his team that is “always willing” to take on new challenges and skillsets.
“[With] the dedication of my surgeon, my cardiology faculty, the nurses and advanced practitioners in the pediatric cardiac [intensive care unit], we were able to do this,” McCulloch said. “We wouldn’t be able to do this [or] offer [this operation] otherwise … [and that ultimately is] why we were able to make this available.”
Isabela Delgado is a staff writer on the news desk who enjoys writing longer form pieces. Most of her work is focused on U.Va. Health and the Honor Committee, although she enjoys writing all types of articles for the paper. Outside of writing, Isabela is also a part of the Photo desk. Isabela is from New Jersey and currently plans to major in Government.
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