Coronary Artery Disease
Impella-assisted chronic total occlusion percutaneous coronary interventions: A multicenter retrospective analysis
Robert F. Riley MD, MS,
James M. McCabe MD, Sanjog Kalra MD, MS,
Mohamad Lazkani MD,
Ashish Pershad MD,
Darshan Doshi MD, Ajay J. Kirtane MD, SM, William Nicholson MD, Katherine Kearney MD, Tony Demartini MD, J. Aaron Grantham MD,
Jeffrey Moses MD, William Lombardi MD, Dimitri Karmpaliotis MD, PhD,
Corresponding Author
Robert F. Riley MD, MS
The Christ Hospital Heart and Vascular Center and The Lindner Research Center, Cincinnati, Ohio
Correspondence Robert F. Riley, The Christ Hospital Heart and Vascular Center, 2139 Auburn Ave, Cincinnati, OH 45219. Email: [email protected]Search for more papers by this authorSanjog Kalra MD, MS
Albert Einstein College of Medicine, New York
Search for more papers by this authorMohamad Lazkani MD
Banner University Medical Center Clinic, Arizon
Search for more papers by this authorAshish Pershad MD
Banner University Medical Center Clinic, Arizon
Search for more papers by this authorJ. Aaron Grantham MD
University of Missouri, Kansas City, Missouri
Mid America Heart Institute, Kansas City, Missouri
Search for more papers by this authorRobert F. Riley MD, MS,
James M. McCabe MD, Sanjog Kalra MD, MS,
Mohamad Lazkani MD,
Ashish Pershad MD,
Darshan Doshi MD, Ajay J. Kirtane MD, SM, William Nicholson MD, Katherine Kearney MD, Tony Demartini MD, J. Aaron Grantham MD,
Jeffrey Moses MD, William Lombardi MD, Dimitri Karmpaliotis MD, PhD,
Corresponding Author
Robert F. Riley MD, MS
The Christ Hospital Heart and Vascular Center and The Lindner Research Center, Cincinnati, Ohio
Correspondence Robert F. Riley, The Christ Hospital Heart and Vascular Center, 2139 Auburn Ave, Cincinnati, OH 45219. Email: [email protected]Search for more papers by this authorSanjog Kalra MD, MS
Albert Einstein College of Medicine, New York
Search for more papers by this authorMohamad Lazkani MD
Banner University Medical Center Clinic, Arizon
Search for more papers by this authorAshish Pershad MD
Banner University Medical Center Clinic, Arizon
Search for more papers by this authorJ. Aaron Grantham MD
University of Missouri, Kansas City, Missouri
Mid America Heart Institute, Kansas City, Missouri
Search for more papers by this authorAbstract
Introduction
Patients with coronary chronic total occlusions (CTO) often have concurrent higher-risk anatomy and physiology (significant calcium, left ventricular dysfunction, multivessel disease) that increase their procedural risk. We present a retrospective multicenter case series describing use of the Impella percutaneous ventricular assist device (p-VAD) during CTO PCI.
Methods
We performed a retrospective analysis of self-reported data from five large referral centers from 2013 to 2017 and identified patients that underwent elective, hemodynamically supported CTO PCI with the Impella p-VAD device (2.5 or CP). Preprocedural demographics, procedural invasive hemodynamics and characteristics, and in-hospital outcomes were reported.
Results
About 57 patients (2% of the overall CTO volume of these centers) were included in this retrospective cohort. The primary indication in the majority (78.9%) of cases was chronic angina; in 21.1% the primary indication was for chronic congestive heart failure because of an ischemic cardiomyopathy. The median LVEF was 20% (15%, 30%) and 63.2% were surgical turndowns. Significant proportions of the group underwent multivessel PCI (91.2%), intervention on an unprotected left main or last remaining conduit vessel (35.1%), and/or atherectomy (17.5%). Technical success was 87.7%. In-hospital procedural complications included: vascular injury (5.3%), all-cause death (5.3%), major bleeding (3.5%), stroke (1.8%), and coronary perforation resulting in tamponade (1.8%).
Conclusion
Impella-assisted CTO PCI can be performed with high technical success rates. However, assiduous attention to appropriate case selection is critical, given the periprocedural complication rates reported in this patient population.
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