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Int J Angiol 2013; 22(04): 207-212
DOI: 10.1055/s-0033-1349167
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Percutaneous Hemodynamic Support (Impella) in Patients with Advanced Heart Failure and/or Cardiogenic Shock Not Eligible to PROTECT II Trial

Wei Liu
2   Cardiology Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
,
Venkata Kishore Mukku
1   Division of Cardiology, University of Texas Medical Branch, Galveston, Texas
,
Syed Gilani
1   Division of Cardiology, University of Texas Medical Branch, Galveston, Texas
,
Ken Fujise
1   Division of Cardiology, University of Texas Medical Branch, Galveston, Texas
,
Alejandro Barbagelata
1   Division of Cardiology, University of Texas Medical Branch, Galveston, Texas
› Author Affiliations
Further Information

Publication History

Publication Date:
04 September 2013 (online)

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Abstract

PROTECT I and II trials have tested the efficacy of Impella in patents with high-risk percutaneous coronary intervention (PCI). However, patients with severe hemodynamic instability such as cardiac arrest, ST-segment elevated myocardial infarction (STEMI), or cardiogenic shock were excluded. The objective was to investigate the efficacy of Impella in sicker patient population who were not included in PROTECT trials. These patients merit high-risk PCI who had cardiogenic shock and unstable or decompensated heart failure (HF). From December 2010 to March 2012, 10 consecutive patients with extremely high surgical risk and hemodynamic instability underwent urgent PCI with Impella 2.5 support (Abiomed Inc., Danvers, MA). These patients were presented with advance HF and/or cardiogenic shock. Among the 10 included patients, 3 patients were with cardiac arrest and 1 patient was with acute myocardial infarction. All patients had successful Impella implantation and remained hemodynamically stable during high-risk PCI. Among the 10 patients 2 patients (20%) died within 1 month and 1 patient developed limb ischemia. In high-risk population nonrandomizable to PROTECT trials with advance HF/cardiogenic shock, Impella could be an important tool for hemodynamic support to PCI or could be a bridge to left ventricle assist device to achieve good recovery. Larger studies need to be conducted on this high-risk population.

Keywords

left ventricle assisting device - heart failure - percutaneous coronary intervention - cardiogenic shock
 

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