Left Main and Multi-Vessel Coronary Disease: Should You Ever Call a Surgeon?
At the 2015 San Diego Cardiovascular Interventions Course, Dr. Michael Ragosta, Director of the Cardiac Catheterization Laboratory and Professor of Medicine/Cardiology, University of Virginia Health System, Charlottesville, VA at the San Diego gave a presentation titled “Left Main and Multi-Vessel Coronary Disease: Should You Ever Call a Surgeon?”
Dr. Ragosta provided a comprehensive review of the decision-making process involved in evaluating and developing the best treatment plan for each patient with advanced coronary artery disease. He recommended calling a surgeon and using the heart team approach, which is a multidisciplinary team consisting of interventional cardiologists and cardiothoracic surgeons who critically evaluate the clinical situation of each patient. Individual clinical evaluations include reviewing the angiographic and clinical characteristics, calculating the STS risk score and the Syntax score, identifying diabetes, and evaluating the likelihood of complete revascularization. Complete revascularization is important because it can improve outcomes in certain patients.
Dr. Ragosta reviewed the guidelines for unprotected left main disease and demonstrated how the heart team can use this clinical information to determine the best treatment for patients—PCI, CABG or a hybrid approach for revascularization. Dr. Ragosta concluded that the best decisions are made with a heart team.
- Listen to Dr. Ragosta’s presentation entitled “Left Main and Multi-Vessel Coronary Disease: Should You Ever Call a Surgeon?”
- Learn more about the clinical data associated with Protected PCI.
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/.