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
Chronic Total Occlusion (CTO): Scientific Benefit and Principal Interventional Approach
Chronic total occlusion (CTO) of coronary arteries are found in about 20% of patients undergoing percutaneous coronary intervention (PCI) and in about 50% of post-CABG patients. Specialized centers can now achieve success rates of over 85%, which is a result of technical advancements in retrograde techniques irrespective of the CTO anatomy. Due to the complexity of retrograde CTO-techniques, a consensus paper issued by the EuroCTO-Club requires interventional cardiologists to have sufficient experience in antegrade approaches (>300 antegrade CTO-cases, 50/year) with additional retrograde training (25 retrograde cases each as first and second operator) before becoming an independent retrograde operator. The increased investment in time and technical resources may only be justified if the patient has a clear clinical benefit. However, technical advancements and the clearer evidence that complete revascularization can be achieved in patients with coronary multivessel disease have attracted growing interest in recent years from interventional cardiologists in treating CTO. The chapter will review current knowledge in the interventional treatment of CTO and focuses on indications and the potential benefits for the individual patient being based on the current state of scientific evidence.
Part of the book: Interventional Cardiology
Interventional Therapies for Post-Cardiac Arrest Patients Suffering from Coronary Artery Disease
Acute myocardial infarction and coronary artery disease (CAD) are the most common causes for the development of malignant arrhythmia often leading to cardiogenic shock and cardiac arrest. Structural heart disease represents the main pathology in older patients, whereas young adults mostly suffer from cardiomyopathies and channelopathies. This book chapter delineates modern interventional therapies for patients with cardiogenic shock or aborted cardiac arrest. Epidemiological data on the incidence of malignant arrhythmia depending causing cardiac arrest depending on the presence or absence of CAD and myocardial infarction are presented. Realistic difficulties within clinical decision-making are counterbalanced for and against an early, aggressive and invasive therapeutic approach including early coronary angiography with percutaneous coronary intervention (PCI), targeted temperature management and mechanical cardiac assist devices, depending on the individual clinical presentation and underlying cardiac arrhythmia.
Part of the book: Myocardial Infarction