Trajectories of Cardiac Function Following Treatment With an Impella Device in Patients With Acute Anterior ST-Elevation Myocardial Infarction

Tersalvi, Gregorio; Attinger‐Toller, Adrian; Kalathil, Dhanya; Winterton, Dario; Cioffi, Giacomo Maria; Madanchi, Mehdi; Seiler, T.; Stadelmann, Marc A.; Goffredo, F.; Fankhauser, Patrick; Moccetti, Federico; Wolfrum, Mathias; Toggweiler, Stefan; Bloch, Andreas; Kobza, Richard; Cuculi, Florim; Bossard, Matthias

doi:10.1016/j.cjco.2022.11.002

Cited by 2 publications

(2 citation statements)

References 30 publications

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“…This case report illustrates the benefits of Impella for complex PCIs in comparison to medical management only. The Impella device is gaining popularity in high-risk PCIs because it provides adequate sustenance in hemodynamic circulation by improving pressure and providing about 3.5 l/min of cardiac output [5][6][7]. Although this device has obtained approval in the US and Europe, its use in the UK is currently constrained by factors like the device's price, limited long-term clinical outcome data, and shortage of experienced staff [8].…”

Section: Discussionmentioning

confidence: 99%

Impella-Driven High-Risk Percutaneous Coronary Intervention: A Novel, Single Non-Surgical-Centre Case Report

Ajagbe,

Bello,

Fagbemi

et al. 2023

Cureus

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Complex percutaneous coronary intervention (PCI) procedures have been routinely performed in non-surgical centres in the UK for more than two decades. These procedures follow strict guidelines and recommendations by the British Cardiovascular Intervention Society to ensure a more effective running of PCI programs. Even more so, expected guiding principles necessary for the safe optimisation of complex PCI procedures have also been created. An 81-year-old male was admitted with non-ST-elevation myocardial infarction (NSTEMI) and severely impaired left ventricle ejection fraction (LVEF; 26% according to the cardiac MRI report). Angiogram findings revealed severe multiple-vessel coronary artery disease affecting the following arteries: right coronary artery (RCA), left anterior descending artery (LAD), left circumflex artery (LCx), and intermediate artery (IM). There was also severe disease in the distal left main stem (LMS) bifurcation extending to the ostia of the LAD, LCx, and IM branches. Following a multidisciplinary meeting, the patient underwent Impella-supported high-risk PCI (complex PCI) using the DK crush technique with no peri- and post-procedure complication and a significant LV function improvement (45-49%). This is the first known case of this procedure performed at the Royal Cornwall Hospital in Treliske (RCHT), Truro, Cornwall. This case report highlights that when the decision to choose between coronary artery bypass graft (CABG) and PCI is not straightforward following an individualised risk-stratification scoring system analysis and in the setting of patient comorbidities, a high-risk PCI supported with the Impella device is a suitable alternative with promising short-term and long-term outcomes.

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Section: Discussionmentioning

confidence: 99%

Impella-Driven High-Risk Percutaneous Coronary Intervention: A Novel, Single Non-Surgical-Centre Case Report

Ajagbe,

Bello,

Fagbemi

et al. 2023

Cureus

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“…Decreased MVO 2 due to mechanical unloading also has profound long-term consequences. For example, implantation of Impella within 24 h in patients with anterior ST-segment myocardial infarction is associated with an increased left ventricular ejection fraction after ∼4 months from index event compared to control ( 50 ). The Protect II randomised controlled trial, showed that Impella provided greater CO power, a metric correlated to mortality ( 51 ), compared to other mechanical support devices in cardiogenic shock patients ( 52 ).…”

Section: Mechanical Circulatory Support Devicesmentioning

confidence: 99%

Cardiac mechanics and reverse remodelling under mechanical support from left ventricular assist devices

Pamias-Lopez,

Ibrahim,

Pitoulis

2023

Front. Cardiovasc. Med.

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In recent years, development of mechanical circulatory support devices has proved to be a new treatment modality, in addition to standard pharmacological therapy, for patients with heart failure or acutely depressed cardiac function. These include left ventricular assist devices, which mechanically unload the heart when implanted. As a result, they profoundly affect the acute cardiac mechanics, which in turn, carry long-term consequences on myocardial function and structural function. Multiple studies have shown that, when implanted, mechanical circulatory assist devices lead to reverse remodelling, a process whereby the diseased myocardium reverts to a healthier-like state. Here, we start by first providing the reader with an overview of cardiac mechanics and important hemodynamic parameters. We then introduce left ventricular assist devices and describe their mode of operation as well as their impact on the hemodynamics. Changes in cardiac mechanics caused by device implantation are then extrapolated in time, and the long-term consequences on myocardial phenotype, as well as the physiological basis for these, is investigated.

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Trajectories of Cardiac Function Following Treatment With an Impella Device in Patients With Acute Anterior ST-Elevation Myocardial Infarction

Cited by 2 publications

References 30 publications

Impella-Driven High-Risk Percutaneous Coronary Intervention: A Novel, Single Non-Surgical-Centre Case Report

Impella-Driven High-Risk Percutaneous Coronary Intervention: A Novel, Single Non-Surgical-Centre Case Report

Cardiac mechanics and reverse remodelling under mechanical support from left ventricular assist devices

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