Health Dictionary

Hemodynamic Support for Complex PC

Overview

Pathophysiology

Rapid hemodynamic deterioration and death during PCI can occur due to hypotension, decompensated heart failure, shock, or arrhythmias.^[1]^[2]^[3]

Prevention

Usage of hemodynamic support devices can be helpful in specific circumstances nevertheless, its routine usage is not recommended to reduce cardiovascular events.^[2]^[3]

Hemodynamic Support Devices

Intra-aortic balloon pump
- Can provide minimal hemodynamic support for PCI but is capable of improving coronary and cerebral blood flow.^[1]
- But its usage is limited in patients with severe peripheral artery or aortic disease.^[1]
- One of the advantages of this device is the small catheter size which reduces the risk of vascular access site complications. Moreover, ease of use is another advantage of intra-aortic balloon pump.
The Impella Percutaneous Left Ventricular–assist Devices
- This device provides greater left ventricular support.
- Impella device provides better hemodynamic support compared with balloon counterpulsation.
- Nevertheless, usage of this device is limited in patients with left ventricular thrombus, aortic stenosis, peripheral artery disease, or aortic disease.
Extracorporeal membrane oxygenation and the Tandem-Heart devices
- These devices are rarely used in order to support complex PCI

2021 ACA Revascularization Guideline

Class 2b Recommendation, Level of Evidence: B-R ^[1]
Using an appropriate hemodynamic support device in the elective settings and among selected patients is reasonable to prevent hemodynamic compromise during PCI.

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). “2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines”. J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check |pmid= value (help).
↑ ^2.0 ^2.1 Perera D, Stables R, Thomas M, Booth J, Pitt M, Blackman D; et al. (2010). “Elective intra-aortic balloon counterpulsation during high-risk percutaneous coronary intervention: a randomized controlled trial”. JAMA. 304 (8): 867–74. doi:10.1001/jama.2010.1190. PMID 20736470.
↑ ^3.0 ^3.1 O’Neill WW, Kleiman NS, Moses J, Henriques JP, Dixon S, Massaro J; et al. (2012). “A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study”. Circulation. 126 (14): 1717–27. doi:10.1161/CIRCULATIONAHA.112.098194. PMID 22935569.

[pmid34895950-1] 1.0 ^1.1 ^1.2 ^1.3 Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). “2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines”. J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check |pmid= value (help).

[pmid20736470-2] 2.0 ^2.1 Perera D, Stables R, Thomas M, Booth J, Pitt M, Blackman D; et al. (2010). “Elective intra-aortic balloon counterpulsation during high-risk percutaneous coronary intervention: a randomized controlled trial”. JAMA. 304 (8): 867–74. doi:10.1001/jama.2010.1190. PMID 20736470.

[pmid22935569-3] 3.0 ^3.1 O’Neill WW, Kleiman NS, Moses J, Henriques JP, Dixon S, Massaro J; et al. (2012). “A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study”. Circulation. 126 (14): 1717–27. doi:10.1161/CIRCULATIONAHA.112.098194. PMID 22935569.

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