Effects of mechanical circulatory support on coronary pressure in patients with critical coronary stenosis
Basir M, Alqarqaz M, Alaswad K, O'Neill W. Effects of mechanical circulatory support on coronary pressure in patients with critical coronary stenosis. Catheter Cardiovasc Interv. 2017;89:S47.
Catheter Cardiovasc Interv
Background: Mechanical circulatory support (MCS) devices are frequently used in high-risk percutaneous coronaryinterventions (HR-PCI) due to their improved effects onsystemic hemodynamics. Little is known on the effects ofsuch devices on coronary hemodynamics in patients withcritical coronary stenosis. Prior studies using intra-aortic balloon pump have failed to demonstrate significant improvements in coronary hemodynamic in patients withcritical coronary stenosis. We therefore sought to investigate if more robust forms of MCS would improve coronary hemodynamics in critical coronary stenosis. Methods: From November 2015 to November 2016 we examined coronary perfusion pressures and distal coronarypressures, using a pressure wire (Volcano Corp. San Diego, CA), in 7 patient undergoing HRPCI with the use of MCS devices. Baseline hemodynamic were obtained after delivery of MCS. MCS was adjusted to a low output state and a high output state according to device specific recommendations and measurements were made prior to PCI. Results: Mean patient age was 79±10 years, 71% were male, and 42% had a left ventricular ejection fraction <30%. 100% of patients had critical coronary stenosis withobstructive lesion ranging from 80-99% diameter stenosisestimated visually. 71% of cases required rotational atherectomy. One patient underwent chronic total occlusion PCI. 5 patients were treated with Impella CP (Abiomed. Danver, MA), 1 patient with Impella 5.0, and one patient with Tandem Heart (Cardiac Assist Inc. Pittsburgh, PA). When MCS was increased from a low output state to a high output state coronary perfusion pressure increased by an average of 21±13.2 mmHg. Similarly, mean distal coronary pressure increased by 9±7 mmHg. Conclusion: MCS devices can improve coronary perfusion pressure even with critical coronary stenosis. This may have implications on selecting the appropriate MCS in patients with criticaland multi-vessel coronary artery disease.