scholarly journals Case series of high-risk percutaneous coronary intervention with rotational atherectomy under short-term mechanical circulatory support with TandemHeart in the setting of acute myocardial infarction

2020 ◽  
Vol 4 (4) ◽  
pp. 1-6
Author(s):  
Leonie Großekettler ◽  
Bastian Schmack ◽  
Hugo A Katus ◽  
Raffi Bekeredjian ◽  
Philip Raake
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Mechanical Circulatory Support ◽  
Case Series ◽  
Coronary Intervention ◽  
Circulatory Support ◽  
Assist Device ◽  
Ventricular Assist ◽  
Percutaneous Coronary

Abstract Background  TandemHeart is a percutaneous Ventricular Assist Device, most commonly used to provide mechanical circulatory support during high-risk percutaneous coronary intervention and postcardiotomy cardiac failure. However, TandemHeart has not been applied in patients with severe heart failure due to myocardial infarction during high-risk percutaneous coronary intervention with the need for rotational artherectomy (RA) before, so we present a first-in-man case series. Case summary  Three patients with severe HF[Please spell out HF, LA and MI (if necessary).] due to acute myocardial infarction revealed severely calcified lesions of the unprotected left main artery. We successfully used the TandemHeart as percutaneous Ventricular Assist Device during high-risk percutaneous coronary intervention with RA. Discussion  We here report our experience and show that RA under TandemHeart mechanical circulatory support is feasible and safe in case of acute MI.

Abstract 16040: High-risk Percutaneous Coronary Intervention Without Mechanical Circulatory Support in Acute Coronary Syndrome

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nauman Khalid ◽  
Hasan Javed ◽  
Cheng Zhang ◽  
Corey Shea ◽  
Evan Shlofmitz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
High Risk ◽  
Mechanical Circulatory Support ◽  
Coronary Intervention ◽  
Left Ventricular Ejection ◽  
Circulatory Support ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Background: Use of mechanical circulatory support (MCS) for high-risk percutaneous coronary intervention (HRPCI) remains controversial with lack of randomized evidence and associated complication risks from these devices. We investigated whether performing HRPCI without elective MCS in patients with acute coronary syndrome (ACS) is safe and feasible. Methods: A single-center, retrospective analysis was done for patients presenting with ACS meeting HRPCI criteria (defined by Interventional Council of American College of Cardiology) including unprotected left main disease, last remaining conduit, left ventricular ejection fraction<35%, 3-vessel coronary artery disease, severe aortic stenosis or severe mitral regurgitation. Clinical, procedural, major in-hospital and 30-days cardiovascular outcomes were assessed. Results: From 2003-2018, 1992 patients (2887 lesions) with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI) and 920 patients (1328 lesions) with ST-segment elevation myocardial infarction (STEMI) underwent HRPCI. The study population had 64.8% men and 52.9% Caucasians in UA/NSTEMI-group and 64.3% men and 53.7% Caucasians in STEMI-group. Mean age for UA/NSTEMI and STEMI patients were 68.6+/-12.69 and 64.52+/-13.54 years respectively. Procedural success was achieved in 96.5% of UA/NSTEMI and 97.9% of STEMI patients. In-hospital and 30-day all-cause mortality was 2.1% for UA/NSTEMI and 4.7% for STEMI patients. Bailout MCS was required in 2.4% of UA/NSTEMI and 9.9% of STEMI patients. Rates of major complications for UA/NSTEMI and STEMI were low, except for renal failure (Panel A). Panel B provides HRPCI criteria distribution. Conclusions: HRPCI without elective MCS is safe and feasible in majority of ACS patients challenging the current practices of professional societies. A randomized trial comparing unprotected vs. protected HRPCI for ACS patients is warranted to identify patients that would benefit from MCS.

Percutaneous Mechanical Circulatory Support Devices Use in Cardiogenic Shock and High-Risk Percutaneous Intervention.

2021 ◽  
Vol 8 (08) ◽  
pp. 5578-5583
Author(s):  
Usman Sarwar ◽  
Nikky Bardia ◽  
Amod Amritphale ◽  
Hassan Tahir ◽  
MD Ghulam M.Awan
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Coronary Intervention ◽  
Percutaneous Intervention ◽  
Circulatory Support ◽  
Percutaneous Coronary ◽  
Mechanical Circulatory Support Devices ◽  
Support Devices

Statistical data has shown that patients now treated in cardiac catheterization laboratories are older with several comorbidities, including renal failure, diabetes, and heart failure [1]. In past patients who were not suitable candidates for percutaneous coronary intervention due to their numerous comorbidities now seems to be a suitable candidate due to tremendous advancements in the field of interventional cardiology like new stent design and availability of advance mechanical circulatory support devices, i.e., Impella performing PCI on these high-risk patients become a viable option. There are two areas of cardiology in which mechanical circulatory support devices keep evolving: one is high-risk (percutaneous coronary intervention) PCI, and the other is a cardiogenic shock that is refractory to initial pressor support.  In this article, we review evidence base data regarding the use of mechanical circulatory support devices in high-risk percutaneous intervention and cardiogenic shock.

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