Impella‐assisted chronic total occlusion percutaneous coronary interventions: A multicenter retrospective analysis. Issue 7 (18th July 2018) - Riley, Robert F.
Abstract: Introduction: Patients with coronary chronic total occlusions (CTO) often have concurrent higher‐risk anatomy and physiology (significant calcium, left ventricular dysfunction, multivessel disease) that increase their procedural risk. We present a retrospective multicenter case series describing use of the Impella percutaneous ventricular assist device (p‐VAD) during CTO PCI. Methods: We performed a retrospective analysis of self‐reported data from five large referral centers from 2013 to 2017 and identified patients that underwent elective, hemodynamically supported CTO PCI with the Impella p‐VAD device (2.5 or CP). Preprocedural demographics, procedural invasive hemodynamics and characteristics, and in‐hospital outcomes were reported. Results: About 57 patients (2% of the overall CTO volume of these centers) were included in this retrospective cohort. The primary indication in the majority (78.9%) of cases was chronic angina; in 21.1% the primary indication was for chronic congestive heart failure because of an ischemic cardiomyopathy. The median LVEF was 20% (15%, 30%) and 63.2% were surgical turndowns. Significant proportions of the group underwent multivessel PCI (91.2%), intervention on an unprotected left main or last remaining conduit vessel (35.1%), and/or atherectomy (17.5%). Technical success was 87.7%. In‐hospital procedural complications included: vascular injury (5.3%), all‐cause death (5.3%), major bleeding (3.5%), stroke (1.8%), and coronary perforation resulting in tamponade (1.8%). Conclusion: Impella‐assisted CTO PCI can be performed with high technical success rates. However, assiduous attention to appropriate case selection is critical, given the periprocedural complication rates reported in this patient population.