Roadmap towards an institutional Impella programme for high-risk coronary interventions

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Device Technology

Background:

• Coronary artery disease (CAD) is a leading cause of global mortality.
• High-risk percutaneous coronary intervention (HR-PCI) in patients with extensive CAD and comorbidities poses risks of hemodynamic instability.
• Mechanical circulatory support (MCS) is vital for maintaining perfusion during HR-PCI.

Purpose of the Study:

• To provide a technological overview of the Impella device for left ventricular support during HR-PCI.
• To share experiences and propose a roadmap for implementing institutional Impella programs.
• To outline a strategy for patient selection and periprocedural care in HR-PCI.

Main Methods:

• A 10-step implementation framework for institutional Impella programs was developed.
• Key steps include staff training, SOP development, multidisciplinary patient selection, and procedural planning.
• Emphasis on periprocedural monitoring and post-procedure multidisciplinary care.

Main Results:

• The proposed 10-step program addresses critical aspects of Impella implementation for HR-PCI.
• Successful implementation requires dedicated staff, standardized procedures, and comprehensive patient management.
• The roadmap facilitates selection and care for patients undergoing HR-PCI with Impella support.

Conclusions:

• A structured, multidisciplinary approach is crucial for the successful implementation of Impella programs in HR-PCI.
• Adherence to the proposed 10-step roadmap can optimize patient selection and periprocedural care.
• This framework aims to improve outcomes for patients undergoing complex, high-risk interventions requiring mechanical circulatory support.