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Published on: June 12, 2021
A Review of Bleeding Risk with Impella-supported High-risk Percutaneous Coronary Intervention
George W Vetrovec1, Amir Kaki2, Thom G Dahle3
1Pauley Heart Center, Virginia Commonwealth University (VCU) Health, VCU, Richmond, VA, USA.
Insights
High-risk percutaneous coronary intervention (HR-PCI) increasingly uses Impella heart pumps for mechanical circulatory support (MCS). This review examines bleeding and vascular complications associated with Impella use in HR-PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- High-risk percutaneous coronary intervention (HR-PCI) is frequently performed with mechanical circulatory support (MCS).
- Impella heart pumps are increasingly used for MCS in HR-PCI, offering greater hemodynamic support than traditional devices.
- Large-bore access required for Impella devices is linked to potential bleeding and vascular complications.
Purpose of the Study:
- To comprehensively review reported bleeding and vascular complications associated with Impella-supported HR-PCI.
- To consolidate variable published data on the risks of large-bore access for Impella devices.
Main Methods:
- Systematic review of published reports on bleeding and vascular complications in Impella-supported HR-PCI.
- Analysis of data concerning the incidence and nature of complications related to large-bore access.
Main Results:
- Data on bleeding and vascular complications associated with large-bore access for Impella devices are highly variable.
- Impella-related bleeding risk is a significant factor influencing clinical decisions for planned use in HR-PCI.
Conclusions:
- Further investigation is needed to better define the risk-benefit profile of Impella use in HR-PCI.
- Understanding complication rates is crucial for optimizing patient selection and procedural management during Impella-supported HR-PCI.
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.
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