SPC365

Use of catheter-based left ventricular assistance devices in high-risk PCI: on the edge of a new frontier

Session: Posters (Sessão 3 - Écran 8) - Intervenção coronária
Speaker: Diogo De Almeida Fernandes

Congress: CPC 2023
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 12. Coronary Artery Disease (Chronic)
Subtheme: 12.4 Coronary Artery Disease – Treatment
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Diogo De Almeida Fernandes; Joana Guimarães; Gonçalo Costa; Eric Monteiro; João Rosa; Ana Vera Marinho; Luís Paiva; Joana Silva; José Luís Martins; Luís Leite; Manuel Oliveira-Santos; Elisabete Jorge; Natália António; Marco Costa; Lino Gonçalves

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>INTRODUCTION</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Catheter-based left ventricular assistance devices (C-LVAD) are a novel solution increasingly used for circulatory support during high-risk percutaneous interventions (HR-PCI). Our purpose was to describe and assess the outcomes of patients who underwent HR-PCI while on Impella or Implantable Ventricular Assist Device (IVAD) support.</span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>METHODS</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">We analysed 18 consecutive patients who underwent HR-PCI on C-LVAD, from July 2017 to November 2022. Clinical, laboratory echocardiographic, angiographic and procedural data were collected. Coronary artery disease burden was graded using the British Cardiovascular Intervention Society Jeopardy Score (BCIS-JS). Follow-up information of Major Adverse Cardiovascular Events (MACE), admissions for heart failure, New York Heart Association (NYHA) functional class and survival was collected. We also analysed possible contributing to negative outcomes.</span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>RESULTS</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Mean age was 67.72 &plusmn; 9.02 years. Most patients were male (16, 88.9%) with an average body mass index of 27.01 &plusmn; 3.26 Kg/m<sup>2</sup> and underwent Impella implantation (16 vs 2). Patients presented more frequently with chronic coronary syndrome (11, 61.1%), followed by NSTEMI (6, 33.3%) and STEMI (1, 5.6%). Nineteen patients had multivessel disease (22.2%) and 4 had critical left main disease (22.2%). Most patients had severe left ventricular dysfunction (11; 61.1%). Mean left ventricular ejection fraction (LVEF) was 30.56 &plusmn; 8.51%. Mean BCIS-JS was 9.44 &plusmn; 2.04.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Stroke occurred in 2 patients (11.1%) post-procedure, significant haemorrhage in 3 (16.7%) and pseudoaneurysm in 1 (5.6%). No cases of lower limb ischemia were reported. A patient presenting with STEMI was the only case of in-hospital mortality (5.6%). Post-procedure haemoglobin was significantly lower (- 1.18 &plusmn; 0.87 g/dL, p &lt; 0.001) and PCR significantly higher (+ 0.71 &plusmn; 1.12 mg/dL). There were no significant changes in troponin, creatinine, blood urea nitrogen and creatinine kinase. Lower haemoglobin prior to PCI was the only statistically significant association with complications (11.79 &plusmn; 1.72 g/dL vs 13.61 &plusmn; 1.80 g/dL; p 0.035).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Overall follow-up time was 20.98 &plusmn; 19.52 months. During this period, the composite endpoint of MACE, heart failure admission and death occurred in 4 patients (22.2%). Of note, only 1 patient died after discharge.</span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>CONCLUSION</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">C-LVAD is a powerful asset when dealing with HR-PCI in the cath lab. Overall mortality and complication rates are low. Patients with anaemia should be approached with greater caution due to increased risk of complications.</span></span></p>