iVAC2L: New Contribution to Ventricular Assist Devices in High Risk PCIs

The use of mechanical circulatory support (MCS) is on the rise, or increasingly necessary, seeing as high risk percutaneous coronary interventions (HR-PCIs) with severe ventricular dysfunction are more and more common. 

MCS can be pulsatile, such as the IABP, highly available but with limited clinical benefit, or continuous, which are more effective, especially the Impella, though considerably more expensive. 

The iVAC2L MCS is pulsatile and uses the same console as IABP, which facilitates implementation. However, although a few studies point out its benefit, its efficacy has not been totally established. 

The analysis looked at 293 patients undergoing HR PCI with iVAC2L.

Primary end point was in-hospital all-cause mortality.

Mean age was 71; mean SYNTAX score was 33; and ejection fraction 30%. Most were men and pesented comorbidities: hypertension (77%), diabetes (38%), prior MI (52%), stroke (9%), prior PCI (38%), prior CABG (34%) and kidney function deterioration (23%). Half of patients were no candidates for CABG. 

Read also: Post IVL Coronary Compliance.

56% presented three vessel disease, 35% unprotected left main lesion and 72% multivessel lesion. 

Mean device useage time was 67 minutes, with a significant increase in arterial systolic, diastolic, mean pressure and minute volume, as well reduced Wedge pressure, through the latter had no statistical significance. 

Primary end point was 1%; MI rate 0,7%; MACE 3,1%; major bleeding 1%; and severe hypotension 9%.

Conclusion

The present analysis suggest the use of iVAC2L allows hemodynamic improvement with low rate of adverse events. However, validating these findings require further analysis. 

Original Title: Pulsatile Left Ventricular Assistance in High-Risk Percutaneous Coronary Interventions: Short-Term Outcomes. 

Reference: Josko Bulum, et al. https://doi.org/10.3390/jcm13185357.