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Published on: June 12, 2021
Mechanical Circulatory Support for Complex High-risk Percutaneous Coronary Intervention
Alexander G Truesdell1,2, Rhian Davies3, Moemen Eltelbany2
1Virginia Heart Falls Church, VA.
Insights
Advancements in percutaneous coronary interventions and mechanical circulatory support enable complex procedures for high-risk patients. Multidisciplinary heart teams are crucial for managing these complex cases effectively.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Technological innovations enhance percutaneous coronary interventions (PCI).
- New mechanical circulatory support (MCS) devices improve outcomes for patients with reduced left ventricular function.
- These advances allow complex PCI in previously untreatable high-risk patients.
Purpose of the Study:
- To review the current state of complex PCI and MCS.
- To highlight the role of these technologies in managing high-risk cardiovascular patients.
- To discuss the evidence supporting the use of MCS in conjunction with complex PCI.
Main Methods:
- Review of current technological and procedural innovations in PCI.
- Analysis of observational data on MCS use in complex PCI.
- Discussion of ongoing and upcoming randomized clinical trials.
Main Results:
- Complex PCI can now be safely performed in higher-risk patient populations.
- MCS provides vital circulatory and ventricular support during complex PCI.
- Observational data support MCS integration into multidisciplinary treatment plans for high-risk patients.
Conclusions:
- Combined advances in PCI and MCS expand treatment options for high-risk patients.
- Multidisciplinary heart team approach is essential for optimal management.
- Further evidence from randomized trials is anticipated to refine treatment strategies.
Abstract:
Technological and procedural innovations presently permit the safe and effective performance of increasingly complex percutaneous coronary interventions, while new mechanical circulatory support devices offer circulatory and ventricular support to patients with severely reduced left ventricular systolic function and deranged cardiovascular hemodynamics. Together, these advances now permit the application of complex percutaneous coronary interventions to higher-risk patients who might otherwise be left untreated. Increasing observational data support the use of mechanical circulatory support in appropriate complex and high-risk patients as part of a larger multidisciplinary heart team treatment plan. In-progress and upcoming randomized clinical trials may provide higher-quality evidence to better guide management decisions in the near future.
