The population is aging, which is closely related with the presence of aortic stenosis. This condition, as we know, is associated with coronary artery disease (CAD) approximately in 50% of cases. In high risk surgical patients, this calls for procedures such as percutaneous coronary intervention (PCI) and transcatheter aortic valve replacement (TAVR). PCI with ventricular…
Axillary Access for Microaxial Ventricular Support Device Placement
There is little evidence in support of the axillary access for counterpulsation balloon insertion, but this evidence is null when it comes to microaxial ventricular support device placement (the Impella device family). Clinical indication of short-term mechanical circulatory support devices has been on the rise. Many patients present suboptimal iliofemoral access or early mobilization is…
Multiple vs. Culprit vessel MI in Cardiogenic Shock: Anything New?
The Shock Trial, the one that set revascularization as the standard strategy to treat all STEMI and cardiogenic shock lesions, had not been discussed for nearly 20 years. The CULPRIT-SHOCK was presented at TCT 2017 (and also in NEJM), and again this one study changed the standard completely, since we went back to treating only…
Impella and Adverse Events
Long after AHA 2019 had presented observational studies showing adverse events associated to Impella, JAMA is finally publishing the official results including all charts and small print. The controversial analysis of the American registry had suggested worse outcomes with the intravascular microaxial left ventricular assist device Impella vs. the intra-aortic balloon pump in acute myocardial…
Impella: A Revolutionary Device Being Questioned
Observational studies (with their subsequent limitations) show a possible increase in adverse events and costs with the use of the Impella device. Two large observational studies stirred doubts regarding the good performance of new circulatory support devices in real-world daily clinical practice. There were more adverse events, including in-hospital death and major bleeding, and more…
AHA 2018 | More Evidence for the Impella Device, But Larger Trials Are Necessary
In this pilot study, unloading the left ventricle with the Impella CP circulatory support device and delaying angioplasty by about 30 minutes appeared to be feasible and safe in patients with acute myocardial infarction without cardiogenic shock. This work sought to test the hypothesis that the device reduces ischemia-reperfusion injury. The trial included 50 patients who had the…
Impella Improves Safety in High Risk Unprotected Left Main PCI
Courtesy of Dr. Carlos Fava. The incidence of unprotected left main severe stenosis ranges between 4 and 8%, and it’s mostly associated with multivessel disease. The use of left ventricular support devices in high risk unprotected left main PCI is on the rise, but not much information available in this regard. Read also: “Prior assistance…
Prior assistance with Impella 2.5 lowers 30-day mortality in cardiogenic shock due to unprotected left main coronary artery lesion
Courtesy of Dr. Carlos Fava. The prevalence of cardiogenic shock in acute myocardial infarction (MI) is 7%-10%, and it is associated with high mortality rates. Unfortunately, 0.7% of these cases are a consequence of unprotected left main coronary artery (ULMCA) as MI-culprit lesion. Its evolution is generally disastrous. Ventricular assist device support and its implementation time may…
Is Impella an option in high-risk angioplasty?
Courtesy of Dr. Carlos Fava. Provitional ventricular assist devices are increasingly used in high-risk angioplasties, particularly those involving unprotected left main coronary artery (LMCA) with defective ventricular functioning. However, so far its true role has not been well-studied. This study analyzed 127 consecutive patients in the USpella registry from 2008 to 2015. These subjects underwent high-risk…
Infarction in Cariogenic Shock: Prioritizing the Use of Impella Could Improve Survival
This small study suggests the early use of Impella ventricular support device in patients undergoing AMI complicated by cardiogenic shock could help lower mortality rate in this population. However, study design should moderate our enthusiasm, mainly because of the cost of this device. Detroit Cardiogenic Shock Initiative has stressed early identification of cardiogenic…