Dr. Karim Ibrahim Shares His Experiences With High-Risk PCI & Impella
The ProtectedPCI.com Blogging Team attended the Abiomed Advanced Interventional Course in Frankfurt, Germany where we interviewed Dr. Karim Ibrahim, a member of the faculty. Dr. Ibrahim shared data from his site in Dresden, Germany, covering his experience using Impella during the course.
Interviewer: We're here with Dr. Karim Ibrahim at the Abiomed advanced interventional course in Frankfurt, Germany. Dr. Ibrahim is a member of the faculty and shared data from his site in Dresden, Germany about his experience using Impella during the course. How does this experience impact your referral pattern, and what kind of cases are involved with these high risk PCIs?
Dr. Ibrahim: We get a few patients from other clinics, especially if they have a complex coronary anatomy and further co-morbidities, especially decreased left ventricular function. The peripheral clinics just send the patients to us, because they know about our experience with the Impella system. We perform the Protected PCI safely with a lot of time and with stable patients. Afterwards, we send them back to the peripheral clinics just for long term aftercare.
Interviewer: As a leading Protected PCI institution in your region, does your center see an increasing number of referrals for more complex patients?
Dr. Ibrahim: We see this. In the last month we get more and more patients that are specially transferred for Protected PCI in our center.
Interviewer: How would you describe the clinical characteristics of your Protected PCI patients who come in through referrals?
Dr. Ibrahim: I think patients that are at highest risk are those who have a severely decreased ejection fraction. Severely decreased means 25% or even lower, and complex anatomy. Sometimes you cannot know what you will expect during the PCI. Sometimes you think it's an easy lesion and you fall into many, many complexities and complications. The Protected PCI gives you time to solve these problems and to perform the PCI with a very good result in the end.
Interviewer: What are the most important factors for an institution to consider before instituting a Protected PCI program?
Dr. Ibrahim: When clinics want to start a Protected PCI program they should start with selected cases with a good theoretical education in the beginning and the first cases with support of anybody who had done already a few cases. Afterwards, they will see that the handling of the Impella system isn't that difficult. Always you need a good preparation for these cases. You have to prepare for difficulties. In the end, you have to do frequently some cases with the Impella system so that you'll train to it and stay familiar with the system.
Interviewer: Fantastic. Thank you very much for your comments today at the Abiomed advanced interventional course.
Dr. Ibrahim: Thank you very much.
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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 www.protectedpci.com/indications-use-safety-information/.