From the Henry Ford Hospital, Detroit, MI.
Circ Cardiovasc Interv. 2018 Apr;11(4):e005870. doi: 10.1161/CIRCINTERVENTIONS.117.005870.
Mechanical circulatory support devices are used to maintain hemodynamic stability during high-risk percutaneous coronary interventions. Little is known on the effects of such devices on coronary hemodynamics in patients with significant coronary stenosis. We sought to investigate whether mechanical circulatory support in the form of Impella (Abiomed Inc, Danvers, MA) can improve coronary hemodynamics in the presence of a critical coronary stenosis.
We examined coronary perfusion pressures and coronary pressure distal to a critical stenosis using a coronary pressure wire in 11 patients (12 coronary lesions) undergoing high-risk percutaneous coronary interventions with the use of mechanical circulatory support. Systemic, ventricular, and coronary hemodynamics were obtained at both minimum and maximum support levels before high-risk percutaneous coronary interventions. All patients had obstructive lesions with angiographically estimated diameter stenosis between 70% and 99% and distal coronary artery pressure to aortic pressure ratios between 0.44 and 0.88. When compared with minimum support, maximum support resulted in a decrease in the left ventricular end-diastolic pressure (27.3±8.6 versus 21.5±5.2 mm Hg; =0.002) and increases in the mean systemic blood pressure (77.6±13.5 versus 88.2±12.2 mm Hg; <0.001) and mean distal coronary pressure (51.8±20.2 versus 60.8±18.1 mm Hg; <0.001). Effective coronary perfusion pressure (mean aortic pressure-left ventricular end-diastolic pressure) significantly increased with maximum support (49.8±15.7 versus 67.2±13.6 mm Hg; <0.001). Diastolic perfusion pressure (diastolic blood pressure-left ventricular end-diastolic pressure) also significantly increased with maximum support (32.9±13.4 versus 52.0±11.6 mm Hg; <0.001).
Mechanical circulatory support with Impella can improve distal coronary pressure and coronary perfusion pressures in the presence of critical coronary stenosis.
机械循环支持装置用于在高危经皮冠状动脉介入治疗期间维持血液动力学稳定。对于有严重冠状动脉狭窄的患者，此类装置对冠状动脉血液动力学的影响知之甚少。我们试图研究在存在临界冠状动脉狭窄的情况下，以 Impella（Abiomed Inc，Danvers，MA）形式的机械循环支持是否可以改善冠状动脉血液动力学。
我们在 11 名接受高危经皮冠状动脉介入治疗的患者（12 个冠状动脉病变）中使用冠状动脉压力导丝检查临界狭窄处冠状动脉的灌注压和冠状动脉远端压力。在高危经皮冠状动脉介入治疗之前，在最低和最高支持水平下获得全身、心室和冠状动脉血液动力学。所有患者均存在血管造影估计直径狭窄 70%至 99%的阻塞性病变和远端冠状动脉压与主动脉压比值为 0.44 至 0.88。与最低支持相比，最大支持导致左心室舒张末期压降低（27.3±8.6 与 21.5±5.2 mmHg；=0.002），平均全身血压升高（77.6±13.5 与 88.2±12.2 mmHg；<0.001）和平均远端冠状动脉压力升高（51.8±20.2 与 60.8±18.1 mmHg；<0.001）。有效冠状动脉灌注压（平均主动脉压-左心室舒张末期压）在最大支持下显著增加（49.8±15.7 与 67.2±13.6 mmHg；<0.001）。舒张期灌注压（舒张压-左心室舒张末期压）在最大支持下也显著增加（32.9±13.4 与 52.0±11.6 mmHg；<0.001）。
Impella 机械循环支持可改善临界冠状动脉狭窄患者的远端冠状动脉压力和冠状动脉灌注压。
