The use of percutaneous left ventricular assist device in high-risk percutaneous coronary intervention and cardiogenic shock.
Patients with high-risk coronary lesions may be denied coronary artery bypass grafting due to excessive comorbidities. Percutaneous coronary intervention (PCI) may be a feasible revascularization strategy in high-risk patients who present with ST-elevation myocardial infarction and cardiogenic shock. Historically, the use if intra-aortic balloon pump (IABP) has been used in high-risk PCI and cardiogenic shock. However, recent data has shown that elective IABP insertion did not reduce the incidence of major cardiovascular events following PCI. The use of a left ventricular assist device is a reasonable and safe alternative compared with IABP counterpulsation, giving greater cardiac output and hemodynamic support in patients undergoing high-risk PCI and in those with severe cardiogenic shock. This review outlines a case of severe cardiogenic shock and hemodynamic instability where high-risk PCI is a reasonable option.
Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Andre Babak
AB
Akhondi
Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Michael S
MS
Lee
D000368:Aged; D017023:Coronary Angiography; D006353:Heart-Assist Devices / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D020127:Recovery of Function; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D016277:Ventricular Function, Left