High-risk percutaneous coronary intervention with Impella CP hemodynamic support. A case series and method presentation

Introduction

Advanced age and additional co-morbidities in patients suffering from coronary artery disease (CAD), with complex coronary lesions including multi-vessel and unprotected left main (ULM), preclude surgical revascularization due to high perioperative morbidity and mortality. For such patients, percutaneous coronary intervention (PCI) may be the only alternative, even if there is a significant technical challenge and procedural risk.
Percutaneous hemodynamic support may be favorable during high-risk PCI [1–3]. Intra-aortic balloon pump (IABP) counter-pulsation is the most commonly used approach. Its benefit of improving long-term survival after high-risk PCI was confirmed in a recent meta-analysis [4]. However, IABP only modestly increases cardiac output and coronary blood flow, and may provide insufficient circulatory support when a hemodynamic collapse occurs [2, 3]. The Impella CP axial flow pump (ABIOMED Inc., Danvers MA, USA) is another percutaneous device, which offers more effective hemodynamic support compared to IABP [5, 6].
We describe five cases of patients who underwent complex PCI supported by the Impella CP, which is a novel approach in Poland [7].

Cases report

Demographic, clinical and procedural data are summarized in Table I. All patients were men with mean age of 78.8 ±8.2 years and mean left ventricular ejection fraction (LVEF) of 29.4 ±13.4%. Baseline coronary lesions’ localization in angiography and final PCI results in two illustrative patients are shown in Figure 1. High risk was determined based on clinical presentation with myocardial infarction (MI) (4 patients), impaired LV function, advanced age, significant co-morbidities, chronic heart failure symptoms and complex lesions with unprotected distal left main and multi-vessel disease. The PCI was performed in AUTO mode and all patients received drug-eluting stent (DES), after rotablation in 1 patient. Impella CP was removed in all patients immediately after PCI and the femoral artery was closed with two Perclose ProGlide (Abbott Vascular, CA, USA) devices. Clinical status has improved in all patients and there were no deaths during 30-day follow-up.

Circulatory support with the Impella CP

The Impella CP Circulatory Support System is a 14 Fr size micro-axial blood pump, mounted on a 9 Fr catheter, which aspirates the blood from the LV cavity and expels it to the ascending aorta [8]. With its maximal speed of 46,000...


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