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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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Published on: June 12, 2021

Impella™-protected PCI in a post-CABG patient with advanced biventricular dysfunction and mitral regurgitation

Mohamed Ayoub1, Saad Ezad2,3, Roberto Lorusso4,5

  • 1Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstrasse 11, 32545 Bad Oeynhausen, Germany.

European Heart Journal Supplements : Journal of the European Society of Cardiology
|June 29, 2026
PubMed

Insights

Protected percutaneous coronary intervention (PCI) using mechanical circulatory support can enable complex revascularization in high-risk patients. This case demonstrates a staged Impella-assisted PCI strategy for post-CABG patients with advanced heart disease when surgery is not feasible.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Surgery

Background:

  • Patients with advanced coronary artery disease (CAD), reduced left ventricular (LV) ejection fraction, and prior coronary artery bypass grafting (CABG) face complex revascularization challenges.
  • Percutaneous coronary intervention (PCI) with temporary mechanical circulatory support offers a potential solution for high-risk individuals.
  • Individualized, multidisciplinary decision-making and pre-procedural planning are crucial for these complex cases.

Purpose of the Study:

  • To describe a case of successful complex revascularization in a post-CABG patient with advanced CAD and LV dysfunction using a staged Impella-assisted PCI strategy.
  • To illustrate the feasibility and safety of this approach when surgical revascularization is not an option.

Main Methods:

  • A staged approach was employed, starting with mitral transcatheter edge-to-edge repair.
  • Prophylactic Impella-assisted PCI was then performed under hemodynamic support.
  • Retrograde chronic total occlusion (CTO) PCI with drug-eluting stent implantation and intravascular ultrasound optimization was successfully completed.

Main Results:

  • The patient remained hemodynamically stable throughout the procedures.
  • The patient experienced an uneventful post-procedural course with no vascular or cardiac complications.
  • Successful revascularization with TIMI 3 flow was achieved in the CTO lesion.

Conclusions:

  • A staged Impella-protected PCI strategy can facilitate complex revascularization in post-CABG patients with advanced LV dysfunction.
  • This approach can be integrated into a patient-tailored strategy considering ventricular function, valvular disease, and complex coronary anatomy.
  • This case highlights a viable alternative for patients with prohibitive surgical risk.

Keywords:
Chronic total occlusionHigh-risk PCIImpellaIschaemic cardiomyopathyMitral regurgitationMultivessel CADProtected PCIReduced LVEF

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