Využití systému Impella 2,5 u vysoce rizikovéperkutánní koronární intervence

The Impella 2.5 is the left ventricle assist device dedicated for short-term circulatory support up to five days. This device is introduced transfemorally, across the aortic valve, used for expelling of blood from the left ventricle to ascending aorta up to 2,5 l/min. The authors describe five case reports about the use of this circulatory support in one year periode (October 2009 to September 2010), in cases of percutaneous coronary intervention with expected high-risk of periprocedural cardiac arrest. The patients were 4 men and 1 woman, age 58-73 years, with severe systolic left ventricular dysfunction, in which cardiac surgery was not indicated because of the high perioperative risk. In one case, the percutaneous coronary intervention was performed in incipient cardiogenic shock. In two cases, the coronary interventions were performed transradially. All patients had introduced a separate venous access for vasopresors administration in case of eventual hypotension. The Impella-mediated blood flow was titrated according to the actual hemodynamic status. In four cases, the percutaneous coronary intervention was successful, in one case emergency cardiac surgery for a coronary artery rupture with unsuccessful graft-stent implantation was needed. The Impella device in this case was used throughout the whole perioperative period. After the removal of Impella device, in one case pseudoaneurysm of femoral artery occured, it was solved by manual compression. In one case, surgical treatment of access site bleeding during the multiorgan failure was necessary. During the first 24 hours after procedure no patient died, within 30 days after procedure one patient died for recurrent ventricular fibrillation occured after transfer into regional hospital. The other four patients were discharged home and are monitored in the outpatient department.