Chapters authored
Peripheral Ventricular Assist Devices in Interventional Cardiology: The Impella® Micro-Axial Pump
Coronary artery disease (CAD) presents an ever-growing burden on health systems especially in the Western world. While percutaneous coronary intervention (PCI) is feasible in increasingly complex CAD, certain patient groups possess a high risk for major cardiac adverse events (MACE) during PCI. Poor outcome is associated with significantly depressed left ventricular function, complexity of relevant lesions, and increasing incidence of pre-existing cerebrovascular comorbidities and poor pre-interventional status. However, these risk factors also translate into a high peri-operative risk for coronary artery bypass graft (CABG) rendering some of these patients inoperable. Peripheral ventricular assist devices (pVADs) are temporarily inserted axial or centrifugal pumps that support ventricular output during PCI. The Impella® micro-axial device (Abiomed, Danvers, Massachusetts, USA) is an easily implantable pVAD that may improve patient outcome during PCI in high-risk patients (termed “protected PCI”) and in patients with cardiogenic shock (CS). pVADs in general and the Impella® system in particular play important roles in interventional cardiology and its indications and use will likely expand in the future. This chapter outlines in detail the indications, applications, and future trends concerning the Impella® system. Practical advice is given on the correct implantation of the device.
Part of the book: Interventional Cardiology
Interventional Left Atrial Appendage Closure: Focus on Practical Implications
Catheter-based left atrial appendage closure is an evolving therapy for the prophylaxis of thromboembolic complications in nonvalvular atrial fibrillation patients, which are ineligible for long-term oral anticoagulation. For this indication, it is recommended by the current European guidelines. This review of the existing literature should facilitate the understanding of the therapy’s practical implications. It presents a clinical approach toward a correct patient selection, gives an overview of the different devices and the procedural aspects, reflects differences and benefits between several postprocedural regimens for device surveillance as well as antithrombotic medication and rounds off with a summary of the relevant studies concerning efficacy and safety outcome measures.
Part of the book: Interventional Cardiology