Protected PCI Cases Highlight Day 1 of the 2015 EU Advanced Hemodynamic Course in Frankfurt
The first day of the Advanced Hemodynamic Course hosted by Abiomed was on Thursday, November 5, 2015 in Frankfurt, Germany. The course began with Protected PCI case presentations.
Prof. Nikos Werner, MD from the University Hospital Bonn, Bonn, Germany presented the first case entitled “Elective Protected PCI.” Prof. Werner noted the patient undergoing elective PCI is usually in stable condition, which is different from patients experiencing an acute myocardial infarction or in shock. Prof. Werner described a 77 year old patient with angina CCS 3 and dyspnea NYHA III, an ejection fraction of 35% and chronic obstructive pulmonary disease. Current coronary issues are severe left main equivalent disease extending into the left anterior descending artery and diseased right coronary artery. The patient also had diabetes, hypertension, and hyperlipidemia.
Previous cardiac history included coronary artery bypass graft surgery (CABG) 10 years earlier with left internal mammary artery and saphenous vein graft. The patient was referred for repeat CABG, which the heart team denied. High-risk PCI was suggested as an alternative.
For high-risk PCI, Prof. Werner maintains an added measure of safety by providing hemodynamic support with the Impella device throughout the procedure. This case was difficult because of the severe left anterior descending lesion. However, successful PCI was performed and left main stenting was treated with the kissing balloon procedure. At the end of the case the Impella device was removed and an angiogram of the closure site was taken from the contralateral groin to confirm the absence of vascular abnormalities or bleeding. Having the contralateral site available also makes balloon tamponade possible, if needed.
The second case entitled “Urgent Protected PCI” was reported by Dr. Carlo Briguori, Chief of Interventional Cardiology at Clinica Mediterranea, Neaples Italy. Dr. Briguori described a 77 year old woman with non-ST segment elevation myocardial infarction, acute pulmonary edema and elevated B type natriuretic peptide (BNP) of 1450. Echocardiography showed left ventricular ejection fraction of 30% and moderate mitral regurgitation. Coronary angiography revealed the following occlusions: left main was 70% occluded, distal right coronary artery was 90%, left anterior descending artery was 99% and left circumflex artery was 80%. Syntax score was 21.
The heart team recommended high-risk PCI using the Impella device for hemodynamic support. The left anterior descending artery and left circumflex artery were stented. The left main was treated with the kissing balloon technique. Mean arterial pressure was maintained throughout the procedure with the assistance of the Impella device. The patient was successfully treated and showed improvement in left ventricular function and BNP the next day.
Dr. Briguori mentioned that the Impella device allowed him to completely revascularize multiple coronary arteries in this patient and thus, increase the likelihood of a better outcome for this patient.
The Impella device provides hemodynamic support in patients with low ejection fraction and poor cardiac function. This allows patients to successfully undergo high-risk PCI procedures with complete revascularization and positive outcomes.
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/.