The impact of the Impella RP(R) device on a failing right heart. A modelling and simulation approach to ascertain its potential

Background and Objective: Indications for right ventricular assist device (RVAD) insertion include right heart failure after implantation of a left ventricular assist device or early graft failure following heart transplantation. This study aimed to investigate how the upstream and downstream circulatory network interacts with the Impella RP(R) device. Methods: A numerical model of the Impella RP(R) was implemented within CARDIOSIM(C) software platform for this study. In the numerical configuration, the RVAD aspirated blood from either the right atrium (RA-PA connection) or the right ventricle (RV-PA connection) and delivered it to the pulmonary artery. Only RA-PA connection is the currently used setting for Impella RP(R) in clinical practice. Based on right ventricular (RV) decompression and total flow, our study may help define the need for a direct RV-unloading Impella RP(R). Results: The simulations showed that activating the RVAD in RA-PA mode, regardless of its rotational speed, the mean pulmonary artery pressure (PAP) percentage change was higher than the unsupported condition when the mean systemic venous pressure (SVP) and the pulmonary artery wedge pressure (PAWP) were both set to 20 mmHg. When RV-PA connection was applied, a similar trend was observed although the PAP percentage changes were about halved compared to the RA-PA connection. Conclusions: The Impella RP(R) has the potential to become a valid option for RV support based on current experimental and simulation data. Although already in use, further evaluation in the clinical setting will likely confirm its potential and lead to a more routinely application for RV support.