Impella®, Percutaneous Left Ventricular Assist Device for Cardiogenic Shock

5.0 with maximum fl ow of 6 L/min), and Impella RP (Right Percutaneous - designed to support the right ventri-cle). Impella 5.5 is expected to be available in Japan soon. Historically, intra-aortic balloon pumping (IABP) and percutaneous cardiopulmonary support (PCPS) have been widely used for patients with refractory CS. However, multiple clinical studies show that IABP alone may not improve prognosis of refractory CS 10, 11) . Some of those refractory CS patients may benefi t from PCPS in terms of survival 12) but robust data to validate the strategy is still lacking. The Impella device is hence expected to improve outcomes of patients with drug-resistant acute heart failure including cardiogenic shock as a new therapy option 13) . In Japan, the fi rst implant was done in October 2017 at Osaka University, and since then 1,326 patients have been implanted and enrolled in the Japanese Registry for Percutaneous Ventricular Assist Devices (J-PVAD registry), an investigator-led, pro-Review We report the outcome of patients supported with the Impella device at our institution. Similar to the interim analysis of J-PVAD registry presented at the 84th Annual Scientific Meeting of the Japanese Circulation Society, we observed a worse outcome in patients with AMI cardiogenic shock who received late Impella support. It is also important to highlight that only one patient of this cohort received Impella support before reperfusion at our institute. A door to unloading strategy as opposed to one emphasizing door to balloon combined with earlier initiation of Impella support seems promising 1) and it the creation of a system that embraces door to unloading which is both our institute’s challenge and opportunity to improve outcomes.