Cardiovascular Division, and Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospital, Miller School of Medicine, Miami, Florida, USA.
Catheter Cardiovasc Interv. 2012 Dec 1;80(7):1201-9. doi: 10.1002/ccd.24303. Epub 2012 Apr 17.
To evaluate feasibility and technical outcomes in patients with aortic stenosis (AS) who have undergone high-risk procedures with continuous flow left ventricular (LV) assist, with the Impella 2.5 system (Abiomed, Danvers, MA).
In preparation for transcatheter aortic valve implantation, an increasing number of high-risk patients with severe AS and left ventricular dysfunction are currently considered for percutaneous coronary interventions (PCI) and balloon aortic valvuloplasty (BAV). Hemodynamic support may be required in some patients.
We reviewed procedural and clinical findings and 30-day outcomes in patients with symptomatic AS who underwent high-risk percutaneous procedures supported by the Impella 2.5 system. All patients carried a high-risk of operative mortality. Impella was used during PCI, BAV, and for hemodynamic support during emergencies.
Over a 14-month period, 21 patients with AS underwent insertion of Impella prior to high-risk PCI (n = 3), BAV with subsequent PCI (n = 8), BAV alone (n = 7), or during cardiac arrest immediately following BAV (n = 3). The mean Society of Thoracic Surgeons (STS) predicted mortality risk was 14% (range 7.3-24.7%). Impella was inserted successfully in all patients attempted. Retrograde advancement of two catheters across the aortic valve (for concomitant BAV in 15 patients) was technically feasible. Retrograde continuous flow LV assist produced a reduction in LV end-diastolic pressure and an increase in arterial pressure. Periprocedural complications occurred in 19% (n = 4) patients, with no periprocedural deaths. Mortality at 30 days was 14.2%.
Our data suggests that continuous flow LV assist with Impella 2.5 can be used in high-risk patients with severe AS who require periprocedural hemodynamic support.
评估经皮冠状动脉介入治疗（PCI）和球囊主动脉瓣成形术（BAV）高危患者使用持续血流左心室（LV）辅助的 Impella 2.5 系统治疗主动脉瓣狭窄（AS）的可行性和技术结果。
为了准备经导管主动脉瓣植入术，目前越来越多严重 AS 和左心室功能障碍的高危患者被考虑进行经皮冠状动脉介入治疗和球囊主动脉瓣成形术。一些患者可能需要血流动力学支持。
我们回顾了接受 Impella 2.5 系统支持的症状性 AS 高危经皮手术的程序和临床发现及 30 天结果。所有患者均有手术死亡的高危风险。在 PCI、BAV 期间以及 BAV 后出现紧急情况时使用 Impella 进行血流动力学支持。
在 14 个月的时间内，21 例 AS 患者在高危 PCI（n = 3）、BAV 后行 PCI（n = 8）、单纯 BAV（n = 7）或 BAV 后立即心脏骤停期间（n = 3）前插入 Impella。预测死亡率的 STS 平均风险为 14%（范围 7.3-24.7%）。所有尝试的患者均成功插入 Impella。在 15 例患者中，有 2 个导管逆行穿过主动脉瓣（用于同期 BAV）在技术上是可行的。逆行连续血流 LV 辅助降低 LV 舒张末期压力，增加动脉压。19%（n = 4）的患者发生围手术期并发症，无围手术期死亡。30 天死亡率为 14.2%。
我们的数据表明，严重 AS 高危患者需要围手术期血流动力学支持时，可使用 Impella 2.5 进行连续血流 LV 辅助。
