The first experience in performing high-risk percutaneous coronary interventions using the transaortic short-term left ventricular support system PulseCath IVAC 2L

• Tarasov R.S.
• Danilovich A.I.
• Pevzner D.V.
• Avetisyan E.A.
• Ganykov V.I.

Abstract

Background. The “gold standard” in the treatment of patients with multivessel disease is coronary artery bypass grafting (CABG) (with artificial circulation or on a beating heart). However, the severity of the intervention (traumatic access, artificial circulation, duration of the operation) does not allow it to be performed safely in all patients for a number of reasons (severe concomitant pathology, technical difficulties, morphology of coronary lesions). Endovascular interventions using mechanical hemodynamic support became the method of choice in the treatment of this cohort of patients.

Aim – analysis of the first experience of high-risk PCI using the PulseCath IVAC 2L transaortic system for short-term left ventricular support.

Material and methods. In September 2023, in the Research Institute for Complex Issues of Cardiovascular Diseases performed five PCI procedures for the first time in high-risk patients using the mechanical support of the PulseCath device. Taking into account the severity of the initial condition of the patients, open coronary artery bypass surgery was refused to the patients due to the high risk of complications. However, to improve the quality of life and further prognosis by preventing the development of adverse cardiovascular events, it was decided to perform PCI with mechanical support using the PulseCath device, despite the high risk of intervention.

Results. Five patients underwent PCI in conditions of mechanical support by the “Pulse Death” device. In the postoperative period, events such as death, myocardial infarction, acute cerebrovascular accident, repeated unplanned myocardial revascularization, ischemic and hemorrhagic complications from vascular access were evaluated. During the analysis of the hospital period, no significant cardiovascular events were recorded. Before discharge, all patients underwent echocardiographic control, according to which positive dynamics was noted, namely, an increase in the ejection fraction of the left ventricle, as well as a decrease in the volume parameters of the left ventricle.

Conclusion. High-risk PCI in conditions of mechanical circulatory support is a possible option in clinical practice in comorbid patients with complex multivessel coronary lesion and contraindications to coronary bypass surgery.

Keywords:mechanical support; multivessel disease; high risk; pulsecath

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