Health innovation from Berlin: a medical company develops a miniature pump that is placed directly into the heart – Berlin

Contemplative cafés and small shops surround a backyard in the center of Berlin-Schoeneberg. At first glance, do not expect high medical technology in this rather inconspicuous place. Yet it is a spectacle of a remarkable development in cardiology, because Abiomed is located here.

The American medical technology company operates two locations in Germany under its Abiomed Europe subsidiary. The main office is located in Aachen, where it produces mainly 400 employees. With 16 employees and an extensive laboratory, Berlin is an important location for the company’s development, specializing in the development and manufacture of miniature cardiac assist systems. The target group includes heart attack patients whose heart muscle needs temporary support.

Impella ECP continues the current series of pumps. Clinical trials involving several hundred patients are due to begin in the coming months. Impella ECP was developed by a team of doctors, engineers and scientists in the company’s laboratories in Berlin. Abiomed publicly advertised the device as “the world’s smallest heart pump.” This cannot be verified reliably.

In fact, the pump is very small. It is ten centimeters long, and only three millimeters in diameter. However, it must be powerful enough to replace a large portion of the heart’s normal pumping force – at least about five liters per minute – for a certain period of time. The center of its power is a small fan built into the structure, the so-called impeller. The name of the product is also derived from it.

In the view of Abiomed Europe Managing Director and developer of Impella Thorsten Siess, the pump is a “technological breakthrough”. The display of the device at least gives an idea of ​​why. While other heart pumps are usually attached to the heart externally or operate entirely outside the body, Impella is placed directly into the heart.

The pump is directed to the heart via a catheter

Siss demonstrates this on a sample. First, the pump, located at the tip of a long guide wire, is inserted into a thin, flexible five-foot tube. This tube is also called a catheter. The proboscis is pushed and pumped together through the great inguinal artery into the body, with feeling, more and more through the vessels just in front of the heart. There he releases the pump from the surrounding catheter and directs it through the aorta and atrium into the left ventricle.

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A zigzag called a pigtail at the tip prevents injuries. The device, which is three millimeters thick, suddenly becomes a heart pump twice its diameter when it is detached from the catheter. In the left ventricle, a small fan sucks blood at speeds of up to 50,000 per minute to force it back into the main artery – the aorta – at the other end. From there it is transferred to different areas of the body.

A view of the Abiomed laboratory in Berlin in Schöneberg.Photo: Doris Spekerman Klass

The Impella ECP is the first expandable heart pump in the series. A remote control-sized motor at the other end of the wire outside the body drives them. There is a long development process behind it. “It took 22 years from the idea to the first patient trial in 2021,” says Sieß.

The challenge was primarily to get as much performance as possible in the smallest device possible. Because the larger the diameter of the catheter-assisted pump, the more likely it is that something will go wrong when it is inserted and left in the body, explains Alexander Ghanem, a spokesperson for the Interventional Cardiology Working Group of the German Society of Cardiovascular Diseases. Chief Physician at the Asklepios Nord Hospital in Hamburg.

This is especially true when cardiologists have less experience on the job. “The price of these pumps is poor circulation in the leg as it is inserted into the body and bleeding at the puncture site,” Ghanem says. So developing smaller pumps is definitely beneficial. “Especially in smaller clinics, every millimeter is really a big deal. If you want to get the pumps into the general supply, three millimeters is really much better than four millimeters.”

Patients whose heart is no longer pumping enough blood should benefit

A problem with it: “The diameter of the pump is strongly related to the blood flow it can create,” Sis explains. “Unless you make it expandable.” While other three-millimeter pumps in the series can handle a maximum delivery volume of two liters of blood per minute, the Impella ECP pump can manage up to four and a half liters when expanded. “This enables us to provide significant support to the heart, so we can actually cover the majority of indications with the pump.”

Patients who have experienced cardiogenic shock as a result of a heart attack, for example, and whose heart is no longer able to pump enough blood into the circulation, should benefit primarily from the pump system. Hence it is urgently dependent on temporary support. None of the previously available Impella pumps were designed for long-term use as an artificial heart. As a rule, the pumps are removed again after a few days at the latest. After all, the goal is always to restore at least part of the heart’s function, according to Sis.

The administration of the drug is not without controversy

So far, patients have received support after cardiogenic shock, often in the form of medications, such as the stress hormone adrenaline. This increases the activity of the heart. But drugs are not without controversy, they not only increase activity, but also increase the oxygen consumption of the heart.

Cardiologist Ghanem explains its effect: “You have to imagine the heart after a cardiogenic shock like a horse pulling a very heavy cart. With drugs, this horse is whipped, so to speak. This works well sometimes, but at some point the horse collapses.” So medication is not a sustainable solution. Large replacement heart-lung machines that are located outside the body and take over the function of gas exchange and pumping are relatively difficult to use.

Thus, mini heart pumps are actually a good treatment option, Ghanem says. According to Abiomed, it has already been used in more than 200,000 patients worldwide. Despite the weak scientific evidence to date, the currently in force guidelines of the European Society of Cardiology also recommend its use in cardiogenic shock, Ghanem says. “These catheter-based pumps are, to keep up with the metaphor, a tractor that takes the pressure off the horse at work for a while. Once the horse has recovered, the tractor can be unscrewed and removed.”

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