Department of Cardiology, West German Heart Center Essen, University Duisburg-Essen, Hufelandstr. 55, D-45122 Essen, Germany.
Int J Cardiol. 2011 Nov 17;153(1):59-63. doi: 10.1016/j.ijcard.2010.08.039. Epub 2010 Sep 9.
To evaluate feasibility, safety, efficacy as well as acute and short-term outcome of hemodynamically supported percutaneous coronary intervention (PCI) by a percutaneous, catheter-based left ventricular assist device (LVAD) (Impella LP 2.5, Abiomed Europe GmbH, Aachen, Germany) in a high-risk patient population with acute coronary syndrome.
Although hemodynamic support by intraaortic balloon pump favorably affects myocardial oxygen supply and demand, it has modest effects on cardiac output, providing passive support only. In contrast, the Impella LP 2.5 microaxial pump, which is placed within the left ventricular outflow tract and actively ejects blood into the ascending aorta, might offer additional hemodynamic support and thereby procedural safety during PCI.
Thirty-eight consecutive high-risk patients (mean age, 69.7 ± 10.3 years, logistic EuroSCORE, 22.4 ± 14.9%) with unstable angina pectoris or non-ST-segment elevation myocardial infarction and severe three-vessel-disease were included in the study. Clinical and laboratory examinations were performed at baseline as well as at 6, 24 and 48 h after the procedure and 30 days after discharge.
Device insertion and explantation was feasible in all patients without vascular complications and continuous hemodynamic stability was obtained during PCI. PCI was uneventfully performed in all but one patient for technical reasons. One non procedure-related death occurred 7 days after the intervention, accounting for a total 30-day mortality of 2.86%. Other major cardiac or cerebrovascular events did not occur.
LVAD support using a percutaneous microaxial flow pump is a promising and safe approach for high-risk PCI providing good short-term results.
评估经皮、导管左心室辅助装置（LVAD）（Abiomed Europe GmbH，德国亚琛的 Impella LP 2.5）在急性冠状动脉综合征高危患者人群中进行血流动力学支持经皮冠状动脉介入治疗（PCI）的可行性、安全性、疗效以及急性和短期结果。
虽然主动脉内球囊泵的血流动力学支持有利于影响心肌氧供需平衡，但它对心输出量的影响有限，只能提供被动支持。相比之下，放置在左心室流出道内并主动将血液喷射到升主动脉中的 Impella LP 2.5 微型轴流泵，可能在 PCI 期间提供额外的血流动力学支持，从而提高手术安全性。
连续纳入 38 例高危患者（平均年龄 69.7 ± 10.3 岁，逻辑 EuroSCORE 为 22.4 ± 14.9%），包括不稳定型心绞痛或非 ST 段抬高型心肌梗死和严重三血管疾病。在基线以及手术后 6、24 和 48 小时以及出院后 30 天进行临床和实验室检查。
所有患者均可行地进行了器械插入和取出，且在 PCI 期间持续保持血流动力学稳定。除一名患者因技术原因外，其余患者的 PCI 均顺利完成。1 例非手术相关死亡发生在干预后 7 天，总 30 天死亡率为 2.86%。没有发生其他主要的心脏或脑血管事件。
使用经皮微型轴流泵的 LVAD 支持为高危 PCI 提供了一种有前途且安全的方法，可获得良好的短期结果。
