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Ferro EG, Kim JM, Lalani C, Abbott DJ, Yeh RW. Mechanical circulatory support for complex, high-risk percutaneous coronary intervention. EUROINTERVENTION 2025; 21:e149-e160. [PMID: 39901631 PMCID: PMC11776407 DOI: 10.4244/eij-d-24-00386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 10/15/2024] [Indexed: 02/05/2025]
Abstract
The evidence base evaluating the use of mechanical circulatory support (MCS) devices in complex, high-risk percutaneous coronary intervention is evolving from a small number of randomised clinical trials to incorporate an amassing body of real-world data. Due to both the growing incidence of the procedures and the limitations of the evidence, there is wide variability in the use of MCS, and the benefits are actively debated. The goal of this review is to perform an integrated analysis of randomised and non-randomised studies which have informed clinical and regulatory decision-making in contemporary clinical practice. In addition, we describe forthcoming studies that have been specifically designed to advance the field and resolve ongoing controversies that remain unanswered for this complex, high-risk patient population.
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Affiliation(s)
- Enrico G Ferro
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Joseph M Kim
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Christina Lalani
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Dawn J Abbott
- Lifespan Cardiovascular Institute, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Vallabhajosyula S, Alasnag M, Boudoulas KD, Davidson LJ, Pyo RT, Riley RF, Shah PB, Velagapudi P, Batchelor WB, Truesdell AG. Future Training Pathways in Percutaneous Coronary Interventions: Interventional Critical Care, Complex Coronary Interventions, and Interventional Heart Failure. JACC. ADVANCES 2024; 3:101338. [PMID: 39741647 PMCID: PMC11686056 DOI: 10.1016/j.jacadv.2024.101338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 08/01/2024] [Accepted: 08/02/2024] [Indexed: 01/03/2025]
Abstract
While there has been a proliferation of training and practice paradigms in the realm of noncoronary interventions, coronary disease remains the predominant pathology necessitating interventional cardiology expertise. The landscape of coronary disease has also experienced a significant transformation due to rapidly evolving technologies, clinical application of mechanical circulatory support and other device innovations, and increasing acuity and complexity of patients. The modern interventional cardiologist is subject to challenges including decreasing coronary procedural volume, need to maintain clinical and financial productivity, and often also requirements of continued scholastic pursuit. Therefore, in the coming decade, there will be greater impetus to develop expertise in multiple new domains of practice. In this document, we propose 3 training paradigms that may assist the tertiary/quaternary center coronary interventional cardiologist to develop a unique clinical/scholastic niche, maintain clinical skills and productivity, and develop care models for complex patients within local and regional tertiary/quaternary hospitals.
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Affiliation(s)
- Saraschandra Vallabhajosyula
- Section of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Brown University Health Cardiovascular Institute, Providence, Rhode Island, USA
| | - Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Konstantinos Dean Boudoulas
- Division of Cardiovascular Medicine, Department of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Laura J. Davidson
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Robert T. Pyo
- Division of Cardiology, Department of Medicine, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, USA
| | - Robert F. Riley
- Overlake Medical Center and Clinics, Bellevue, Washington, USA
| | - Pinak B. Shah
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Poonam Velagapudi
- Division of Cardiovascular Medicine, Department of Medicine, University of Nebraska School of Medicine, Omaha, Nebraska, USA
| | - Wayne B. Batchelor
- Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Alexander G. Truesdell
- Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- Virginia Heart, Falls Church, Virginia, USA
| | - Critical Care Cardiology Working Group of the American College of Cardiology Interventional Section Leadership Council
- Section of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Brown University Health Cardiovascular Institute, Providence, Rhode Island, USA
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
- Division of Cardiovascular Medicine, Department of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Cardiology, Department of Medicine, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, USA
- Overlake Medical Center and Clinics, Bellevue, Washington, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Department of Medicine, University of Nebraska School of Medicine, Omaha, Nebraska, USA
- Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- Virginia Heart, Falls Church, Virginia, USA
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Di Muro FM, Bellino M, Esposito L, Attisano T, Meucci F, Mattesini A, Galasso G, Vecchione C, Di Mario C. Role of Mechanical Circulatory Support in Complex High-Risk and Indicated Percutaneous Coronary Intervention: Current Indications, Device Options, and Potential Complications. J Clin Med 2024; 13:4931. [PMID: 39201073 PMCID: PMC11355104 DOI: 10.3390/jcm13164931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 09/02/2024] Open
Abstract
Improved expertise and technological advancements have enabled the safe and effective performance of complex and high-risk-indicated percutaneous coronary intervention (CHIP) in patients previously considered inoperable or high-risk. Mechanical circulatory support (MCS) devices play a crucial role in stabilizing hemodynamics during percutaneous coronary intervention (PCI) -related ischemia, thereby reducing the risk of major adverse events and achieving a more complete revascularization. However, the use of MCS devices in protected PCI is not without risks, including peri-procedural myocardial infarction (MI), bleeding, and access-related complications. Despite numerous observational studies, there is a significant lack of randomized clinical trials comparing different MCS devices in various CHIP scenarios and evaluating their long-term safety and efficacy profiles. This review aims to summarize the current evidence regarding the benefits of MCS devices during CHIPs, offer a practical guide for selecting appropriate devices based on clinical scenarios, and highlight the unanswered questions that future trials need to address.
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Affiliation(s)
- Francesca Maria Di Muro
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, Careggi University Hospital, University of Florence, 50134 Florence, Italy
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Baronissi, Italy; (M.B.); (T.A.); (G.G.); (C.V.)
| | - Luca Esposito
- Department of Advanced Biomedical Sciences, University Federico II, 80138 Naples, Italy;
| | - Tiziana Attisano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Baronissi, Italy; (M.B.); (T.A.); (G.G.); (C.V.)
| | - Francesco Meucci
- Division of Structural Interventional Cardiology, Cardiothoracovascular Department, Careggi University Hospital, 50134 Florence, Italy; (F.M.); (A.M.); (C.D.M.)
| | - Alessio Mattesini
- Division of Structural Interventional Cardiology, Cardiothoracovascular Department, Careggi University Hospital, 50134 Florence, Italy; (F.M.); (A.M.); (C.D.M.)
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Baronissi, Italy; (M.B.); (T.A.); (G.G.); (C.V.)
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Baronissi, Italy; (M.B.); (T.A.); (G.G.); (C.V.)
- Vascular Pathophysiology Unit, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Carlo Di Mario
- Division of Structural Interventional Cardiology, Cardiothoracovascular Department, Careggi University Hospital, 50134 Florence, Italy; (F.M.); (A.M.); (C.D.M.)
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4
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Sandoval Y, Basir MB, Lemor A, Lichaa H, Alasnag M, Dupont A, Hirst C, Kearney KE, Kaki A, Smith TD, Vallabhajosyula S, Kayssi A, Firstenberg MS, Truesdell AG. Optimal Large-Bore Femoral Access, Indwelling Device Management, and Vascular Closure for Percutaneous Mechanical Circulatory Support. Am J Cardiol 2023; 206:262-276. [PMID: 37717476 DOI: 10.1016/j.amjcard.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/30/2023] [Accepted: 08/05/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Yader Sandoval
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Center for Coronary Artery Disease, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Mir B Basir
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Alejandro Lemor
- Department of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Hady Lichaa
- Ascension Saint Thomas Heart, Ascension Saint Thomas Rutherford, Murfreesboro, Tennessee
| | - Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | | | - Colin Hirst
- Department of Cardiology, Ascension St. John Hospital-Detroit, Detroit, Michigan
| | | | - Amir Kaki
- Department of Cardiology, Ascension St. John Hospital-Detroit, Detroit, Michigan
| | - Timothy D Smith
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Division of Public Health Sciences, Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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