Percutaneous Circulatory Assist Devices for High-Risk Coronary Intervention

Abstract A unifying definition of what constitutes high-risk percutaneous coronary intervention remains elusive. This reflects the existence of several recognized patient, anatomic, and procedural characteristics that, when combined, can contribute to elevating risk. The relative inability to withst...

Full description

Saved in:
Bibliographic Details
Published in:JACC. Cardiovascular interventions 2015-02, Vol.8 (2), p.229-244
Main Authors: Myat, Aung, MBBS, Patel, Niket, MBBS, Tehrani, Shana, MD, Banning, Adrian P., MD, PhD, Redwood, Simon R., MD, Bhatt, Deepak L., MD, MPH
Format: Article
Language:English
Subjects:
Angioplasty, Balloon, Coronary
Assisted Circulation - instrumentation
Cardiovascular
Cardiovascular Diseases - surgery
Counterpulsation
diastolic augmentation
Extracorporeal Membrane Oxygenation
Heart-Assist Devices
Hemodynamics
high-risk PCI
Humans
intra-aortic balloon pump
Intra-Aortic Balloon Pumping
mechanical circulatory support
Percutaneous Coronary Intervention - instrumentation
Risk Factors
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract A unifying definition of what constitutes high-risk percutaneous coronary intervention remains elusive. This reflects the existence of several recognized patient, anatomic, and procedural characteristics that, when combined, can contribute to elevating risk. The relative inability to withstand the adverse hemodynamic sequelae of dysrhythmia, transient episodes of ischemia-reperfusion injury, or distal embolization of atherogenic material associated with coronary intervention serve as a common thread to tie this patient cohort together. This enhanced susceptibility to catastrophic hemodynamic collapse has triggered the development of percutaneous cardiac assist devices such as the intra-aortic balloon pump, Impella (Abiomed Inc., Danvers, Massachusetts), TandemHeart (CardiacAssist, Inc., Pittsburgh, Pennsylvania), and extracorporeal membranous oxygenation to provide adjunctive mechanical circulatory support. In this state-of-the-art review, we discuss the physiology underpinning their application. Thereafter, we examine the results of several randomized multicenter trials investigating their use in high-risk coronary intervention to determine which patients would benefit most from their implantation and whether there is a signal to delineate whether they should be used in an elective pre-procedure, standby, rescue, or routine post-procedure fashion.
ISSN:1936-8798
1876-7605
DOI:10.1016/j.jcin.2014.07.030