title: PCI in Patients Supported With CF-LVADs: Indications, Safety, and Outcomes.
abstract: OBJECTIVE
  Patients with heart failure supported with left ventricular assist devices (LVADs) may require coronary intervention during their support. This case series seeks to explore the indications, safety, and outcomes of percutaneous coronary intervention (PCI) in this population.
  
  
  METHODS
  Electronic medical records of patients with LVADs undergoing PCI at a large academic medical center were reviewed. Demographics, reason for PCI, procedural success, complications, and outcomes were collected.
  
  
  RESULTS
  From 2010-2014, a total of 6 patients underwent PCI post LVAD implantation. Three patients had PCI in the early postimplantation period (1-3 days post LVAD implantation) while the other three received it later in the LVAD support period. Three indications for PCI were found in the reviewed cases: right ventricular failure (right coronary artery stenting), bridge to left ventricular recovery, and ventricular tachycardia (VT) storm. All patients were maintained on triple blood thinning therapy (aspirin, clopidogrel, and warfarin). There were no acute complications during the interventions; however, 2 patients died in the early intervention period and 2 died much later. The 2 deaths in the early intervention period were related to fatal gastrointestinal bleeding while on dual-antiplatelet therapy and warfarin, and intractable VT that PCI did not correct. The 2 deaths in the late postintervention period occurred due to unknown causes nearly 1 and 2 years post intervention, respectively.
  
  
  CONCLUSIONS
  PCI was performed in patients with continuous-flow LVAD with several possible indications and without acute complications. The utility of PCI in this patient population, however, is likely limited by the risk of bleeding related to combined antiplatelet and anticoagulation therapies as well as lack of immediate apparent benefit. Further studies are necessary to better characterize this risk as well as quantify any potential long-term benefits.
authors.forename: Emeka C
authors.initials: EC
authors.lastname: Anyanwu
authors.forename: Takeyoshi
authors.initials: T
authors.lastname: Ota
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sayer
authors.forename: Sandeep
authors.initials: S
authors.lastname: Nathan
authors.forename: Valluvan
authors.initials: V
authors.lastname: Jeevanandam
authors.forename: Atman
authors.initials: A
authors.lastname: Shah
authors.affiliation: Professor of Medicine, Medical Director of Heart Failure, Heart Transplant and Mechanical Assist Device Programs, University of Chicago, Division Of Cardiology, Chicago, IL 60637 USA. nuriel@ medicine.bsd.uchicago.edu.
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D017809:Fatal Outcome; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012189:Retrospective Studies