SCAI 2015 Fall Fellows Course Discusses Hemodynamic Support for High-Risk PCI Patients
The SCAI 2015 Fall Fellows course entitled “Protected PCI: Treating the Complex Higher-Risk Indicated Patients (CHIP)” this past weekend in Las Vegas, over 120 fellows from 25 countries. The course focused on the use of hemodynamic support for high-risk PCI patients and the technical and cognitive skills required for cardiology fellows to develop their own Protected PCI program once they complete their Interventional Cardiology fellowship.
The course was run by faculty renowned for their fellowship programs and included didactic sessions, case presentations, and hands-on simulator demonstrations.
The course began with Dr. John Lasala, Director of Interventional Cardiology, Washington University School of Medicine who led a discussion on complex PCI in the modern era of medicine.
Dr. Lasala described the Impella® 2.5, the only FDA-approved hemodynamic support device for treating elective and urgent high-risk PCI patients. He reviewed high-risk PCI with hemodynamic support and its appropriateness for certain high-risk patients with complex coronary artery disease. Such patients are hemodynamically stable, have ejection fraction ≤35%, and possess comorbid conditions such as heart failure, peripheral vascular disease, complex lesions, diabetes, advanced age, unstable angina, non ST-segment elevation myocardial infarction, or prior surgeries.
The Impella 2.5™ heart pump protects the patient hemodynamically during high-risk PCI, and can allow physicians the time needed to conduct complete revascularization. This is important because complete revascularization is associated with improved patient outcomes. “Optimal Revascularization Strategy” was discussed by Dr. George Vetrovec, Abiomed contributor and the former Chairman of Cardiology and Director of the Adult Cardiac Catheterization Laboratory, Virginia Commonwealth University, Richmond, VA.
Dr. Mark Grise, Medical Director of the Cardiac Catheterization Laboratory, Sacred Heart Hospital, discussed support beyond the catheterization laboratory and led the conversation around access and patient management. The support system needed for a successful Protected PCI program includes:
- a physician team that provides quality patient care 24 hours a day, 7 days a
- a positive relationship between cardiology and cardiothoracic surgery,
- well-trained nurses in both the cardiac catheterization laboratory and the cardiac intensive care unit, and;
- administrative and economic support for the complex coronary artery disease program.
The course wrapped up with Dr. Ravi Hira, director of Acute Cardiac Services & Cardiac Catheterization Service at the Harborview Medical Center in Seattle, WA, who described the elements needed to start a Protected PCI Program. The skill of knowing how to use a heart pump in all situations combined with the support mentioned above can result in improved patient care and 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/.