Circulation Editorial Discusses Advances in High-Risk PCI

March 24, 2016

A recent editorial by Dr. Ted Bass from the University of Florida published in Circulation: Cardiovascular Interventions highlights modern advances in technologies and techniques in complex and high-risk PCI. With the advance of these new tools and skills, he discusses the improvements in procedural success rates today relative to inception.

In the article, Dr. Bass differentiates complex PCI from high-risk PCI, an important point, as the “skills and support systems” needed to conduct PCI on both of these patients vary greatly. The difference is best explained with an example of a complex PCI patient: “A middle-aged male with normal left ventricular function and increasing angina presenting for PCI with a heavily calcified bifurcation lesion involving the left anterior descending-first diagonal bifurcation.” This case would be considered high-risk PCI if it were “an elderly male with a chronically occluded right coronary artery and a severely decreased left ventricular ejection fraction.” High-risk patients are not candidates for surgery and certain of those patients should be considered for revascularization with the Impella® heart pump, a percutaneous ventricular assist device.

Dr. Bass concludes by discussing the challenges in developing and maintaining a high-risk PCI program, including the benefits of shorter hospital stays and fewer readmissions. Ultimately, the article highlights the concept of treating patients who are appropriate, high-risk, and may need a Protected PCI procedure.

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About Impella

The Impella 2.5 system is a temporary (<6 hours) ventricular support device indicated for use during high risk percutaneous coronary interventions (PCI) performed in elective or urgent, hemodynamically stable patients with severe coronary artery disease and depressed left ventricular ejection fraction, when a heart team, including a cardiac surgeon, has determined high risk PCI is the appropriate therapeutic option. Use of the Impella 2.5 in these patients may prevent hemodynamic instability which can result from repeat episodes of reversible myocardial ischemia that occur during planned temporary coronary occlusions and may reduce peri- and post-procedural adverse events.

Protected PCI and use of the Impella 2.5 is not right for every patient. Patients may not be able to be treated with Impella if they have certain pre-existing conditions, which a cardiologist can determine, such as: severe narrowing of the heart valve, severe peripheral artery disease, clots in blood vessels, or a replacement heart valve or certain heart valve deficiencies. Additionally, use of Impella has been associated with risks, including, but not limited to valvular and vascular injury, bleeding, and limb ischemia in certain patients. Learn more about the Impella devices’ approved indications for use, as well as important safety and risk information at