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Review
. 2020 Dec 29;14(2):92-99.
doi: 10.17925/HI.2020.14.2.92. eCollection 2020.

A Review of Bleeding Risk with Impella-supported High-risk Percutaneous Coronary Intervention

George W Vetrovec  1 , Amir Kaki  2 , Thom G Dahle  3
Affiliations
Review

A Review of Bleeding Risk with Impella-supported High-risk Percutaneous Coronary Intervention

George W Vetrovec et al. Heart Int. .

Abstract

Complex, high-risk percutaneous coronary intervention (HR-PCI) is increasingly being performed, often with mechanical circulatory support (MCS), though to date, there are limited randomised data on the efficacy of MCS for HR-PCI. The majority of MCS is provided by intra-aortic balloon pumps, but increasingly Impella® (Abiomed, Danvers, MA, USA) heart pumps are being used. While the Impella pumps provide greater increases in cardiac output, these devices require large bore access, which has been associated with an increased risk of bleeding and vascular complications. Decisions regarding the use of Impella are often based on risk-benefit considerations, with Impella-related bleeding risk being a major factor that can impact decisions for planned use. While bleeding risk related to large bore access is a concern, published data on the risk have been quite variable. Thus, the goal of this article is to provide a comprehensive review of reports describing bleeding and vascular complications for Impella-supported HR-PCI.

Keywords: High-risk percutaneous coronary intervention (PCI); PCI bleeding complications; PCI vascular complications; haemodynamic support; mechanical circulatory support; percutaneous left ventricular assist device (pVAD).

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Conflict of interest statement

Disclosures: George Vetrovec has acted as a consultant for Abiomed, Merck and the FDA. Amir Kaki and Thom G Dahle have both acted as a proctor and speaker for Abiomed.

Figures

Figure 1:
Figure 1:. Major bleeding complications as reported across Impella-supported high-risk percutaneous coronary intervention studies conducted from 2004 to 2018
Figure 2:
Figure 2:. Major vascular complications reported across Impella studies by ascending year
Figure 3:
Figure 3:. Rate of transfusions reported across Impella studies by ascending year
See this image and copyright information in PMC

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References

    1. Kataruka A, Maynard CC, Kearney KE. et al. Temporal trends in percutaneous coronary intervention and coronary artery bypass grafting: insights from the Washington Cardiac Care Outcomes Assessment Program. J Am Heart Assoc. 2020;9:e015317. - PMC - PubMed
    1. Waldo SW, Secemsky EA, O’Brien C. et al. Surgical ineligibility and mortality among patients with unprotected left main or multivessel coronary artery disease undergoing percutaneous coronary intervention. Circulation. 2014;130:2295–301. - PMC - PubMed
    1. Bass TA. High-risk percutaneous coronary interventions in modern day clinical practice: current concepts and challenges. Circ Cardiovasc Interv. 2015;8::e003405. - PubMed
    1. Myat A, Patel N, Tehrani S. et al. Percutaneous circulatory assist devices for high-risk coronary intervention. JACC Cardiovasc Interv. 2015;8:229–44. - PubMed
    1. Burkhoff D, Sayer G, Doshi D, Uriel N. Hemodynamics of mechanical circulatory support. J Am Coll Cardiol. 2015;66:2663–74. - PubMed

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