Percutaneous Hemodynamic Support in PCI.

Percutaneous coronary intervention (PCI) procedures are attempted with increasingly frequency in hemodynamically unstable, high-risk, and complex patients. Hemodynamic support can be advantageous in select patients presenting with acute myocardial infarction and cardiogenic shock. The need for hemodynamic support has recently shifted from patients with hemodynamic collapse to support of patients during high-risk complex PCI procedures during elective cases such as left main disease, multivessel disease, or low-flow heart failure. Currently, the three most common types of percutaneous hemodynamic support devices available in the United States are the intra-aortic balloon pump (IABP) and the left ventricular assist devices TandemHeart and Impella. Each of these devices has its advantages and disadvantages, and an understanding of the role each plays in various pathophysiologic conditions is necessary, as this will assist the practitioner in making the correct decision as to which device will optimize patient outcomes. Recent studies have called into question the need for certain devices in specific situations. However, ongoing clinical trials will provide further insight into the comparative advantages and disadvantages of each and whether one or more is beneficial over another in reducing cardiovascular events and mortality. With continued refinements in device technology, technique, and application, it is anticipated that percutaneous device-based procedures will continue to improve patient outcomes in the most critically ill and highest-risk patients.