PIG Meeting: 29th April 2021
74-year-old man for PCI to left main coronary artery prior to vascular surgery
- Intermittent claudication at 100m
- Thrombosed popliteal artery aneurysm, requiring stent
- CABG 22 years ago
- Previous LAD stent, now totally occluded
- Open AAA repair 5 years ago, uneventful
- Lives independently on acreage. Active, Chops wood.
- Elective review by vascular surgeon revealed exertional dyspnoea
- Sestamibi organised by surgical team showed a significant area of reversible ischaemia
- Cardiologist review, proceeded to angiogram
- Previous LAD stent, now totally occluded. All coronary grafts blocked. Native vessels severely blocked.
- If requires PCI it would be High risk– Left-main and LAD disease. Likely need rotablade with significant chance of impaired coronary perfusion and myocardial stunning.
- LVEF = 25%
- Cardiologist advised that if PCI is performed preoperatively, an Impella device would be required
Indication for stress test?
- AHA guidelines would indicate that no myocardial stress imaging is indicated
- Patient can perform > 4mets and is relatively asymptomatic
- Cardiologist opinion that medical management is appropriate given lack of symptomatology
- PCI is requirement for further anaesthesia and vascular surgery
- Vascular symptoms are limiting exercise tolerance
What is an Impella device and why is it used?
- Impella is a centrifugal pump which acts as Left ventricular assist device
- The device pumps blood from the LV into the ascending aorta at an upper rate of 2.5L/min
- Percutaneously inserted via 14fr sheath into the femoral artery
- Multiple indications including high risk PCI. See www.impella.com and Protect II trial.
- Continue to present novel cases such as this to aid in dissemination of knowledge
- Consider presentation at CME
- Note vascular surgical patients have baseline higher risk of significant coronary artery disease