Mechanical Circulatory Support With Impella in High‐Risk Patients With Chronic Total Occlusion and Complex Multivessel Disease

Ignacio Gallo; Lorenzo Azzalini; Rafael González‐Manzanares; Silvia Moscardelli; Alfonso Jurado‐Román; Luis Carlos Maestre; Javier Suarez de Lezo; Francisco Hidalgo; Jorge Perea; Manuel Díaz; Soledad Ojeda; Manuel Pan

doi:10.1002/ccd.31392

journal article Open Access Jan 08, 2025

Mechanical Circulatory Support With Impella in High‐Risk Patients With Chronic Total Occlusion and Complex Multivessel Disease

Ignacio Gallo

Lorenzo Azzalini

Rafael González‐Manzanares Silvia Moscardelli Alfonso Jurado‐Román

Luis Carlos Maestre Javier Suarez de Lezo Francisco Hidalgo

Jorge Perea

Manuel Díaz Soledad Ojeda

Manuel Pan

Catheterization and Cardiovascular Interventions Vol. 105 No. 4 pp. 883-890 · Wiley

View at Publisher Save 10.1002/ccd.31392

Abstract

ABSTRACTBackgroundThe therapeutic management of patients with multivessel disease and severe left ventricular dysfunction is complex and controversial.AimsThe aim of this study was to analyze the clinical outcomes and the changes in left ventricular ejection fraction (LVEF) in patients with severe left ventricular dysfunction and at least one chronic total occlusion (CTO) undergoing percutaneous coronary intervention (PCI) with hemodynamic support provided by Impella.MethodsRetrospective, multicenter study enrolling patients with severe left ventricular dysfunction and severe coronary artery disease with at least one CTO who required percutaneous mechanical circulatory support with Impella, from January 2019 to December 2023. The primary endpoints were the incidence of MACE (composite of cardiovascular death, acute myocardial infarct, and target lesion revascularization) at 90 days. The secondary endpoint was changes in LVEF and functional class during the same period.ResultsA total of 27 patients (34 CTOs) were included in the study. The mean SYNTAX score was 35 ± 11. The median J‐CTO score of 2 (1–3). At 90 day of follow‐up, there were three MACE (11%), two cardiovascular deaths and one TLR; three vascular complications were related to access for the Impella device (only one required invasive treatment); and LVEF improved significantly after revascularization (delta LVEF: 10% [CI 95% 6, 15]). A total of 81% of patients improved their angina or dyspnea status at 90 days.ConclusionsIn high‐risk patients with severe left ventricular dysfunction with complex coronary disease including CTO, PCI with mechanical circulatory support using the Impella device is associated with favorable safety and efficacy outcomes at short‐term follow‐up.

Topics

No keywords indexed for this article. Browse by subject →

References

29

[1]

10.1161/jaha.122.026943

[2]

10.1016/j.jchf.2022.08.009

[3]

Coronary-Artery Bypass Surgery in Patients with Left Ventricular Dysfunction

Eric J. Velazquez, Kerry L. Lee, Marek A. Deja et al.

New England Journal of Medicine 10.1056/nejmoa1100356

[4]

2018 ESC/EACTS Guidelines on myocardial revascularization

Franz-Josef Neumann, Miguel Sousa-Uva, Anders Ahlsson et al.

European Heart Journal 10.1093/eurheartj/ehy394

[5]

10.1016/j.jcin.2022.06.007

[6]

10.1016/j.jcin.2021.09.027

[7]

10.1016/j.ijcard.2023.05.048

[8]

Fourth Universal Definition of Myocardial Infarction (2018)

Kristian Thygesen, Joseph S. Alpert, Allan S. Jaffe et al.

Journal of the American College of Cardiology 10.1016/j.jacc.2018.08.1038

[9]

Standardized End Point Definitions for Coronary Intervention Trials: The Academic Research Consortium-2 Consensus Document

Hector M. Garcia-Garcia, Eugene P. McFadden, Andrew Farb et al.

Circulation 10.1161/circulationaha.117.029289

[10]

10.1161/circulationaha.120.046754

[11]

10.1186/cc5713

[12]

10.1093/ehjci/jev014

[13]

10.1093/ejcts/ezs043

[14]

10.1016/s0140-6736(19)31997-x

[15]

10.1016/j.jcin.2010.09.024

[16]

10.1016/j.jcin.2015.09.022

[17]

10.1161/jaha.116.004272

[18]

10.1016/j.jcin.2022.09.038

[19]

10.4244/eijv8i1a21

[20]

10.1007/s11886-024-02029-2

[21]

10.1016/j.ahj.2022.02.006

[22]

10.1056/nejmoa2206606

[23]

10.1016/j.jscai.2022.100350

[24]

10.1161/circinterventions.121.011284

[25]

10.1093/eurheartj/ehy220

[26]

Danek B. A. "Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Multicenter U.S. Registry" The Journal of Invasive Cardiology (2018)

[27]

10.1016/j.amjcard.2023.05.029

[28]

10.1016/j.amjcard.2022.10.049

[29]

10.1002/ccd.27679

Metrics

4

Citations

29

References

Details

Published: Jan 08, 2025
Vol/Issue: 105(4)
Pages: 883-890
License: View

Authors

I

Ignacio Gallo

Cardiology Department Reina Sofia University Hospital Cordoba Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC) Cordoba Spain

L

Lorenzo Azzalini

Department of Medicine, Division of Cardiology University of Washington Seattle Washington USA

R

Rafael González‐Manzanares

Cardiology Department Reina Sofia University Hospital Cordoba Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC) Cordoba Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV) Madrid Spain

S

Silvia Moscardelli

Department of Medicine, Division of Cardiology University of Washington Seattle Washington USA; Thoracic, Pulmonary and Cardiovascular Department University of Milan Milan Italy

A

Alfonso Jurado‐Román

Cardiology Department La Paz University Hospital Madrid Spain

L

Luis Carlos Maestre

Cardiology Department Reina Sofia University Hospital Cordoba Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC) Cordoba Spain

J

Javier Suarez de Lezo

Cardiology Department Reina Sofia University Hospital Cordoba Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC) Cordoba Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV) Madrid Spain

F

Francisco Hidalgo

Cardiology Department Reina Sofia University Hospital Cordoba Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC) Cordoba Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV) Madrid Spain

J

Jorge Perea

Cardiology Department Reina Sofia University Hospital Cordoba Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC) Cordoba Spain

M

Manuel Díaz

Cardiology Department Reina Sofia University Hospital Cordoba Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC) Cordoba Spain

S

Soledad Ojeda

Cardiology Department Reina Sofia University Hospital Cordoba Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC) Cordoba Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV) Madrid Spain; Department of Medicine University of Cordoba Cordoba Spain

M

Manuel Pan

Cardiology Department Reina Sofia University Hospital Cordoba Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC) Cordoba Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV) Madrid Spain; Department of Medicine University of Cordoba Cordoba Spain

Cite This Article

Ignacio Gallo, Lorenzo Azzalini, Rafael González‐Manzanares, et al. (2025). Mechanical Circulatory Support With Impella in High‐Risk Patients With Chronic Total Occlusion and Complex Multivessel Disease. Catheterization and Cardiovascular Interventions, 105(4), 883-890. https://doi.org/10.1002/ccd.31392

Mechanical Circulatory Support With Impella in High‐Risk Patients With Chronic Total Occlusion and Complex Multivessel Disease

You May Also Like