TCT 2015 Session Reviews CHIP Cases with Focus on Technical Issues
Great case base learning session this morning by Dr Manish Parikh from Columbia University Medical Center in New York. It was case based education with a focus on technical issues. The session discussed how physicians can optimize the care of patients who greatly need revascularization but are high risk due to severe symptoms and surgery inoperability. The CHIP concept was reviewed and several cases were presented. Dr. Parikh mentioned several times that these type of cases require excellent operator skills but need the advantage of hemodynamic support to allow safe, effective and complete revascularization, a point that was repeatedly emphasized.
This still frame from one of the cases tells a lot, demonstrating the complexity level of this type of case. The patient has three coronary wires in, a PA catheter, a defibrillator, and an Impella support device.
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/.