Interv Akut Kardiol. 2011;10(3):122-126

The use of Impella 2.5 in high-risk percutaneous coronary intervention

Jan Pešek¹, Ivo Bernat¹, Jiří Koza¹, Michal Šmíd¹, Jakub Čech¹, Vratislav Pechman¹, Milan Hromádka¹, Jiří Široký², Vladimír Mikulenka², Viktor Zlocha², Tomáš Hájek², Richard Rokyta¹

¹ Kardiologie, I. interní klinika a Oddělení kardiochirurgie FN Plzeň

² Komplexní kardiovaskulární centrum FN Plzeň

The Impella 2.5 is the left ventricle assist device dedicated for short-term circulatory support up to five days. This device is introduced

transfemorally, across the aortic valve, used for expelling of blood from the left ventricle to ascending aorta up to 2,5 l/min. The

authors describe five case reports about the use of this circulatory support in one year periode (October 2009 to September 2010), in

cases of percutaneous coronary intervention with expected high-risk of periprocedural cardiac arrest. The patients were 4 men and 1

woman, age 58–73 years, with severe systolic left ventricular dysfunction, in which cardiac surgery was not indicated because of the high

perioperative risk. In one case, the percutaneous coronary intervention was performed in incipient cardiogenic shock. In two cases, the

coronary interventions were performed transradially. All patients had introduced a separate venous access for vasopresors administration

in case of eventual hypotension. The Impella-mediated blood flow was titrated according to the actual hemodynamic status. In four

cases, the percutaneous coronary intervention was successful, in one case emergency cardiac surgery for a coronary artery rupture with

unsuccessful graft-stent implantation was needed. The Impella device in this case was used throughout the whole perioperative period.

After the removal of Impella device, in one case pseudoaneurysm of femoral artery occured, it was solved by manual compression. In one

case, surgical treatment of access site bleeding during the multiorgan failure was necessary. During the first 24 hours after procedure

no patient died, within 30 days after procedure one patient died for recurrent ventricular fibrillation occured after transfer into regional

hospital. The other four patients were discharged home and are monitored in the outpatient department.

Keywords: high-risk PCI, LVAD, cardiac failure

Published: June 10, 2011  Show citation