Developing a Protected PCI Algorithm

February 26, 2018

Dr. Hiram Bezerra explains how his team created a Protected PCI algorithm and got buy-in from the entire heart team.

Dr. Hiram Bezerra of University Hospital, Cleveland, shares his success in developing a Protected PCI algorithm. He shares his experience in achieving consensus from the entire heart team, including interventional cardiologists, cardiothoracic surgeons, heart failure specialists, and intensivists. Dr. Bezerra suggests that physicians convene a collaborative consultation with the heart team to discuss retrospective case situations as a start to developing an algorithm.

The team’s algorithm includes which includes two entry points: ejection fraction of less than 35% and anatomical and procedural risk independent of EF. The first entry point includes a combination of low EF plus an unprotected left main, multi-vessel intervention, or atherectomy of a large vessel; this is largely the patient population studied in the PROTECT II prospective, multi-center randomized clinical trial. The second entry point is independent of EF, but includes high risk characteristics such as PCI on last remaining conduit, CTO PCI using retrograde technique through last available conduit, CTO PCI using retrograde access via LIMA to LAD, atherectomy of unprotected left main, and distal left main disease with proximal LAD and Circumflex.

In summary, a patient with lesion complexity and a reduced EF may benefit from hemodynamic support. Additionally, patients with high lesion complexity without a reduced EF may also benefit from hemodynamic support.

The team at University Hospital, Cleveland has large posters of the algorithm in the cath labs to increase awareness. As a result of this algorithm, the team has less heterogeneity in decision-making. Watch the video to learn more about patients appropriate for Protected PCI with Impella.

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