Der Einsatz einer perkutanen Impella CP im Rahmen von komplexen Hochrisiko-Koronarinterventionen

Der Einsatz eines perkutanen linksventrikulären Unterstützungssystems eröffnet die Möglichkeit, komplexe Koronarinterventionen unter stabilen hämodynamischen Verhältnissen bei Patienten mit kardialen Vorerkrankungen durchzuführen. Dieser Artikel soll zeigen, auf welche periinterventionellen Besonderheiten zu achten ist, um die Impella CP sicher und erfolgreich einzusetzen.

Schlüsselwörter

Impella - pLVAD - protected PCI - Hochrisiko Koronarinterventionen

• Literatur

• 1 Packer M, Anker SD, Butler J. et al. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. N Engl J Med 2020; 383: 1413-1424
• 2 Tokgözoğlu L, Libby P. The dawn of a new era of targeted lipid-lowering therapies. Eur Heart J 2022; 43: 3198-3208
• 3 Werner N, Burzotta F, Sinning J-M. European best practice: a step forward to optimize Impella-protected percutaneous coronary intervention to improve outcome after high-risk coronary interventions. Eur Heart J 2022; 24: J1-J3
• 4 Lüsebrink E, Kellnar A, Krieg K. et al. Percutaneous Transvalvular Microaxial Flow Pump Support in Cardiology. Circulation 2022; 145: 1254-1284
• 5 Thiele H, Zeymer U, Thelemann N. et al. Intraaortic Balloon Pump in Cardiogenic Shock Complicating Acute Myocardial Infarction: Long-Term 6-Year Outcome of the Randomized IABP-SHOCK II Trial. Circulation 2019; 139: 395-403
• 6 Leick J, Werner N, Mangner N. et al. Optimized patient selection in high-risk protected percutaneous coronary intervention. Eur Heart J 2022; 24: J4-J10
• 7 O’Neill WW, Kleiman NS, Moses J. et al. A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation 2012; 126: 1717-1727
• 8 Abiomed Inc. Impella®-Supported PCI in High-Risk Patients With Complex Coronary Artery Disease and Reduced Left Ventricular Function: The PROTECT IV Trial. Zugriff am 02. Januar 2024 unter: https://clinicaltrials.gov/study/NCT04763200
• 9 Zein R, Patel C, Mercado-Alamo A. et al. A Review of the Impella Devices. Interv Cardiol 2022; 17: e05
• 10 Abiomed Inc. Impella® Die kleinsten Herzpumpen der Welt. Zugriff am 02. Januar 2024 unter: https://www.abiomed.de/produkte-und-services/impella
• 11 Werner N, Akin I, Al-Rashid F. et al. Expertenkonsensus zum praktischen Einsatz von Herzkreislaufunterstützungssystemen bei Hochrisiko-Koronarinterventionen. Kardiologe 2017; 11: 460-472
• 12 Fincke R, Hochman JS, Lowe AM. et al. Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: a report from the SHOCK trial registry. J Am Coll Cardiol 2004; 44: 340-348
• 13 Abiomed Inc. Impella CP® with SmartAssist® – For Use During Cardiogenic Shock and High-Risk PCI. Instructions for Use & Clinical Reference Manual. Aachen: Abiomed Europe GmbH; 2020. Zugriff am 02. Januar 2024 unter: https://www.fda.gov/media/140767/download
• 14 Ott S, Notz Q, Menger J. et al. [The Role of the Percutaneous Impella Pump in Anesthesia and Intensive Care]. Anasthesiol Intensivmed Notfallmed Schmerzther 2023; 58: 304-320
• 15 Ye Z, Lu H, Li L. Reduced Left Ventricular Ejection Fraction Is a Risk Factor for In-Hospital Mortality in Patients after Percutaneous Coronary Intervention: A Hospital-Based Survey. Biomed Res Int 2018; 2018: 8753176
• 16 Neumann F-J, Sousa-Uva M, Ahlsson A. et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2019; 40: 87-165
• 17 Brener SJ, Cunn GJ, Desai PH. et al. A novel risk score to predict one-year mortality in patients undergoing complex high-risk indicated percutaneous coronary intervention (CHIP-PCI). J Invasive Cardiol 2021; 33: E253-E258
• 18 Protty M, Sharp ASP, Gallagher S. et al. Defining Percutaneous Coronary Intervention Complexity and Risk: An Analysis of the United Kingdom BCIS Database 2006–2016. JACC Cardiovasc Interv 2022; 15: 39-49
• 19 Al-Rashid F, Van Mieghem NM, Bonello L. et al. Standardized pre-procedural clinical workup for protected percutaneous coronary intervention. Eur Heart J Suppl 2022; 24: J11-J16
• 20 Baumann S, Werner N, Ibrahim K. et al. Indication and short-term clinical outcomes of high-risk percutaneous coronary intervention with microaxial Impella® pump: results from the German Impella® registry. Clin Res Cardiol 2018; 107: 653-657