Impella ventricular support in clinical practice: Collaborative viewpoint from a European expert user group

•A European expert user group review on the main theoretical principles of Impella•An up-to-date summary of the best practical aspects of Impella technology in a variety of clinical settings•A stepwise approach to plan, start and implement an Impella program

Mechanical circulatory support represents an evolving field of clinical research and practice. Currently, several cardiac assist devices have been developed but, among different institutions and countries, a large variation in indications for use and device selection exists. The Impella platform is an easy to use percutaneous circulatory support device which is increasingly used worldwide.During 2014, we established a working group of European physicians who have collected considerable experience with the Impella device in recent years. By critically comparing the individual experiences and the operative protocols, this working group attempted to establish the best clinical practice with the technology. The present paper reviews the main theoretical principles of Impella and provides an up-to-date summary of the best practical aspects of device use which may help others gain the maximal advantage with Impella technology in a variety of clinical settings.