Mechanical circulatory support devices during percutaneous coronary intervention

TY - JOUR

T1 - Mechanical circulatory support devices during percutaneous coronary intervention

AU - Li Kam Wa, Matthew

AU - De Silva, Kalpa

AU - Perera, Divaka

N1 - Publisher Copyright: © 2022

PY - 2022/7/1

Y1 - 2022/7/1

N2 - The last decade has seen significant changes in our understanding of how to best use mechanical circulatory support (MCS) devices within the cardiac catheter laboratory. The longstanding intra-aortic balloon pump (IABP) has been joined by the newer Impella axial flow pump, offering options for either aortic counterpulsation or continuous forward flow in a variety of clinical conditions, including percutaneous coronary intervention (PCI). Although a series of randomized controlled trials has established that there is no overall benefit with routine use of the IABP, it remains a safe, readily available and quick-to-insert device to support the heart. In contrast, the Impella has demonstrated compelling effects on haemodynamics, being able to augment cardiac output far in excess than that of the IABP; however, although its usage is increasing worldwide, there is a lack of any high-quality clinical outcome data and there are concerns regarding cost and complications from its use. An individualized approach based on device and patient physiology, with meticulous attention to vascular access, is key to the optimal use of MCS devices during PCI.

AB - The last decade has seen significant changes in our understanding of how to best use mechanical circulatory support (MCS) devices within the cardiac catheter laboratory. The longstanding intra-aortic balloon pump (IABP) has been joined by the newer Impella axial flow pump, offering options for either aortic counterpulsation or continuous forward flow in a variety of clinical conditions, including percutaneous coronary intervention (PCI). Although a series of randomized controlled trials has established that there is no overall benefit with routine use of the IABP, it remains a safe, readily available and quick-to-insert device to support the heart. In contrast, the Impella has demonstrated compelling effects on haemodynamics, being able to augment cardiac output far in excess than that of the IABP; however, although its usage is increasing worldwide, there is a lack of any high-quality clinical outcome data and there are concerns regarding cost and complications from its use. An individualized approach based on device and patient physiology, with meticulous attention to vascular access, is key to the optimal use of MCS devices during PCI.

KW - Cardiogenic shock

KW - coronary artery disease

KW - Impella

KW - intra-aortic balloon pump

KW - percutaneous coronary intervention

UR - http://www.scopus.com/inward/record.url?scp=85131064902&partnerID=8YFLogxK

U2 - 10.1016/j.mpmed.2022.04.014

DO - 10.1016/j.mpmed.2022.04.014

M3 - Review article

AN - SCOPUS:85131064902

SN - 1357-3039

VL - 50

SP - 467

EP - 468

JO - Medicine (United Kingdom)

JF - Medicine (United Kingdom)

IS - 7

ER -