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Novel Challenges and Advances in Complex Coronary Interventions
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Novel Challenges and Advances in Complex Coronary Interventions

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Clinical Medicine, Cell, and Organism Physiology".

Deadline for manuscript submissions: closed (30 January 2024) | Viewed by 27398

Special Issue Editor

Dr. Mario Iannaccone

E-Mail Website
Guest Editor
Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, 10100 Turin, Italy
Interests: complex coronary interventions; chronic total occlusion recanalisation; intracoronary imaging; left ventricle mechanical support devices
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Thanks to the technical progress and the safety improvement in interventional procedures, percutaneous coronary intervention and cardiogenic shock are rapidly expanding toward more complex technical and clinical scenarios.

In this clinical setting, the effects of transient coronary occlusion due to the different procedural steps may cause temporary hemodynamic instability. Percutaneous mechanical circulatory support (pMCS) devices emerged as a potential tool to prevent procedure-related hemodynamic compromise by unloading the ventricle and augmenting forward flow, thus potentially reducing ischemia and decreasing myocardial injury ultimately resulting in worse mid and long-term outcomes.

The aim of this issue is to evaluate the role of pMCS in high-risk PCI and primary PCI, in particular Impella and ECMO.

Dr. Mario Iannaccone
Guest Editor

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Keywords

  • complex coronary interventions
  • pMCS
  • PCI
  • Impella
  • ECMO
  • chronic total occlusion recanalization
  • intracoronary imaging
  • left ventricle mechanical support devices

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Published Papers (9 papers)

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Editorial

Jump to: Research, Review

4 pages, 206 KiB  
Editorial
Complex Coronary Interventions: Are We Reaching a Plateau?
by Luca Franchin, Giacomo Boccuzzi, Diego Moniaci and Mario Iannaccone
J. Pers. Med. 2022, 12(8), 1298; https://doi.org/10.3390/jpm12081298 - 8 Aug 2022
Cited by 1 | Viewed by 1434
Abstract
The complexity of coronary artery disease is currently on the rise [...] Full article
(This article belongs to the Special Issue Novel Challenges and Advances in Complex Coronary Interventions)

Research

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12 pages, 1319 KiB  
Article
Impact of in-Hospital Left Ventricular Ejection Fraction Recovery on Long-Term Outcomes in Patients Who Underwent Impella Support for HR PCI or Cardiogenic Shock: A Sub-Analysis from the IMP-IT Registry
by Mario Iannaccone, Luca Franchin, Francesco Burzotta, Giulia Botti, Vittorio Pazzanese, Carlo Briguori, Carlo Trani, Tommaso Piva, Federico De Marco, Giulia Masiero, Maurizio Di Biasi, Paolo Pagnotta, Gavino Casu, Anna Mara Scandroglio, Giuseppe Tarantini and Alaide Chieffo
J. Pers. Med. 2023, 13(5), 826; https://doi.org/10.3390/jpm13050826 - 13 May 2023
Cited by 3 | Viewed by 1739
Abstract
(1) Background: Percutaneous left ventricle assist devices (pLVADs) demonstrated an improvement in mid-term clinical outcomes in selected patients with severely depressed left ventricular ejection fraction (LVEF) undergoing percutaneous coronary interventions. However, the prognostic impact of in-hospital LVEF recovery is unclear. Accordingly, the present [...] Read more.
(1) Background: Percutaneous left ventricle assist devices (pLVADs) demonstrated an improvement in mid-term clinical outcomes in selected patients with severely depressed left ventricular ejection fraction (LVEF) undergoing percutaneous coronary interventions. However, the prognostic impact of in-hospital LVEF recovery is unclear. Accordingly, the present sub-analysis aims to evaluate the impact of LVEF recovery in both cardiogenic shock (CS) and high-risk percutaneous coronary intervention (HR PCI) supported with pLVADs in the IMP-IT registry. (2) Methods: A total of 279 patients (116 patients in CS and 163 patients in HR PCI) treated with Impella 2.5 or CP in the IMP-IT registry were included in this analysis, after excluding those who died while in the hospital or with missing data on LVEF recovery. The primary study objective was a composite of all-cause death, rehospitalisation for heart failure, left ventricle assist device (LVAD) implantation, or heart transplantation (HT), overall referred to as the major adverse cardiac events (MACE) at 1 year. The study aimed to evaluate the impact of in-hospital LVEF recovery on the primary study objective in patients treated with Impella for HR PCI and CS, respectively. (3) Results: The mean in-hospital change in LVEF was 10 ± 1% (p < 0.001) in the CS cohort and 3 ± 7% (p < 0.001) in the HR PCI group, achieved by 44% and 40% of patients, respectively. In the CS group, patients with less than 10% in-hospital LVEF recovery experienced higher rates of MACE at 1 year of follow-up (FU) (51% vs. 21%, HR 3.8, CI 1.7–8.4, p < 0.01). After multivariate analysis, LVEF recovery was the main independent protective factor for MACE at FU (HR 0.23, CI 0.08–0.64, p = 0.02). In the HR PCI group, LVEF recovery (>3%) was not associated with lower MACE at multivariable analysis (HR 0.73, CI 0.31–1.72, p = 0.17). Conversely, the completeness of revascularisation was found to be a protective factor for MACE (HR 0.11, CI 0.02–0.62, p = 0.02) (4) Conclusions: Significant LVEF recovery was associated with improved outcomes in CS patients treated with PCI during mechanical circulatory support with Impella, whereas complete revascularisation showed a significant clinical relevance in HR PCI. Full article
(This article belongs to the Special Issue Novel Challenges and Advances in Complex Coronary Interventions)
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14 pages, 881 KiB  
Article
Predictors and Prognostic Impact of Left Ventricular Ejection Fraction Recovery after Impella-Supported Percutaneous Coronary Interventions in Acute Myocardial Infarction
by Federico Marin, Michele Pighi, Federico Zucchelli, Alessandro Ruzzarin, Giulio Russo, Cristina Aurigemma, Enrico Romagnoli, Valeria Ferrero, Anna Piccoli, Roberto Scarsini, Gabriele Pesarini, Carlo Trani, Francesco Burzotta and Flavio Luciano Ribichini
J. Pers. Med. 2022, 12(10), 1576; https://doi.org/10.3390/jpm12101576 - 24 Sep 2022
Cited by 3 | Viewed by 1907
Abstract
Aim: The aim of our study is to assess the predictors and the prognostic role of left ventricle ejection fraction (LVEF) recovery after Impella-supported percutaneous coronary intervention (PCI) in patients presenting with acute myocardial infarction (AMI). Methods: This retrospective, observational study included patients [...] Read more.
Aim: The aim of our study is to assess the predictors and the prognostic role of left ventricle ejection fraction (LVEF) recovery after Impella-supported percutaneous coronary intervention (PCI) in patients presenting with acute myocardial infarction (AMI). Methods: This retrospective, observational study included patients admitted for AMI who underwent Impella-supported PCI in two Italian high-volume cardiac catheterization laboratories. Only patients who underwent an echocardiographic assessment of left ventricle ejection fraction (LVEF) before the procedure (acute LVEF) and during follow-up (follow-up LVEF) were included in the present analysis. Patients with a baseline LVEF ≥40% were excluded from the present analysis. LVEF recovery was calculated as the difference between follow-up LVEF and acute LVEF. A delta ≥5% was considered significant and was used to define the responder group. Results: From April 2007 to December 2020, 64 consecutive patients were included in our study. A total of 55 patients (86%) received hemodynamic support with Impella 2.5, and 9 patients (14%) with Impella CP. Median LVEF at follow-up was significantly higher compared to baseline (36% (30–42) vs. 30% (24–33), p < 0.001). Based on LVEF recovery, 37 patients (57.8%) were deemed responders. According to multivariate analysis, complete functional revascularization was an independent predictor of a significant EF recovery (OR: 0.159; 95% CI: 0.038–0.668; p = 0.012). At three-year follow-up, lack of LVEF recovery was the only predictor of mortality (HR: 5.315; 95% CI: 1.100–25.676; p = 0.038). Conclusions: Functional complete revascularization is an independent predictor of the recovery of LVEF in patients presenting with AMI who underwent Impella-supported PCI. The recovery of LV function is associated with improved prognosis and could be used to stratify the risk of future events at long-term follow-up. Full article
(This article belongs to the Special Issue Novel Challenges and Advances in Complex Coronary Interventions)
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10 pages, 438 KiB  
Article
Impella RP for Patients with Acute Right Ventricular Failure and Cardiogenic Shock: A Subanalysis from the IMP-IT Registry
by Giulia Botti, Mario Gramegna, Francesco Burzotta, Giulia Masiero, Carlo Briguori, Carlo Trani, Massimo Napodano, Anna Mara Scandroglio, Matteo Montorfano, Giuseppe Tarantini and Alaide Chieffo
J. Pers. Med. 2022, 12(9), 1481; https://doi.org/10.3390/jpm12091481 - 9 Sep 2022
Cited by 9 | Viewed by 2541
Abstract
The use of percutaneous right ventricular assist devices (pRVADs) to support patients with right ventricular (RV)-predominant cardiogenic shock (CS) refractory to optimal medical therapy is increasing progressively, and the Impella RP is the first FDA-approved pRVAD in such a clinical scenario. The aim [...] Read more.
The use of percutaneous right ventricular assist devices (pRVADs) to support patients with right ventricular (RV)-predominant cardiogenic shock (CS) refractory to optimal medical therapy is increasing progressively, and the Impella RP is the first FDA-approved pRVAD in such a clinical scenario. The aim of the present study is to report the outcomes of patients treated with Impella RP in the IMP-IT (IMPella Mechanical Circulatory Support Device in Italy) registry, a multicenter registry that evaluated the trends in use and clinical outcomes of the Impella in the setting of CS and high-risk percutaneous coronary intervention in Italy. A total of 15 patients who received Impella RP were enrolled. In 40% of the patients, the main cause was ST-segment elevation myocardial infarction. A total of 40% of patients required biventricular support with a left Impella. Device-related complications were reported in 46.7% of patients. Overall, the in-hospital mortality was 46.7%, whereas the one-year mortality was 53.3%. The composite rate of all-cause death, heart failure (HF) hospitalization, left ventricular assist device (LVAD) and heart transplant at one year was 60%. The Impella RP has favorable survival outcomes in RV-predominant cardiogenic shock. However, the device-related complications are frequent and should be carefully weighed when considering escalation to Impella RP. Full article
(This article belongs to the Special Issue Novel Challenges and Advances in Complex Coronary Interventions)
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Review

Jump to: Editorial, Research

12 pages, 25597 KiB  
Review
Management of Vascular Access in the Setting of Percutaneous Mechanical Circulatory Support (pMCS): Sheaths, Vascular Access and Closure Systems
by Andrea Sardone, Luca Franchin, Diego Moniaci, Salvatore Colangelo, Francesco Colombo, Giacomo Boccuzzi and Mario Iannaccone
J. Pers. Med. 2023, 13(2), 293; https://doi.org/10.3390/jpm13020293 - 6 Feb 2023
Cited by 5 | Viewed by 2214
Abstract
The use of percutaneous mechanical circulatory support (pMCS), such as intra-aortic balloon pump, Impella, TandemHeart and VA-ECMO, in the setting of cardiogenic shock or in protect percutaneous coronary intervention (protect-PCI) is rapidly increasing in clinical practice. The major problem related to the use [...] Read more.
The use of percutaneous mechanical circulatory support (pMCS), such as intra-aortic balloon pump, Impella, TandemHeart and VA-ECMO, in the setting of cardiogenic shock or in protect percutaneous coronary intervention (protect-PCI) is rapidly increasing in clinical practice. The major problem related to the use of pMCS is the management of all the device-related complications and of any vascular injury. MCS often requires large-bore access, if compared with common PCI, and for this reason the correct management of vascular access is a crucial point. The correct use of these devices in catheterization laboratories requires specific knowledge such as the correct evaluation of the vascular access performed, when possible, with advance imaging techniques in order to choose a percutaneous or a surgical approach. In addition to conventional transfemoral access, other types of access, such as transaxillary/subclavial access and the transcaval approach, have emerged over the years. These other approaches require advanced skills of the operators and a multidisciplinary team with dedicated physicians. Another important part of the management of vascular access is the closure systems used for hemostasis. Currently, two types of devices are typically used in the lab: suture-based or plug-based ones. In this review we want to describe all these aspects related to the management of vascular access in pMCS and describe, finally, a case report from our center’s experience. Full article
(This article belongs to the Special Issue Novel Challenges and Advances in Complex Coronary Interventions)
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15 pages, 687 KiB  
Review
Contemporary Management of Severely Calcified Coronary Lesions
by Natthapon Angsubhakorn, Nicolas Kang, Colleen Fearon, Chol Techorueangwiwat, Pooja Swamy, Emmanouil S. Brilakis and Aditya S. Bharadwaj
J. Pers. Med. 2022, 12(10), 1638; https://doi.org/10.3390/jpm12101638 - 3 Oct 2022
Cited by 17 | Viewed by 5238
Abstract
Coronary artery calcification is increasingly prevalent in our patient population. It significantly limits the procedural success of percutaneous coronary intervention and is associated with a higher risk of adverse cardiovascular events both in the short-term and long-term. There are several modalities for modifying [...] Read more.
Coronary artery calcification is increasingly prevalent in our patient population. It significantly limits the procedural success of percutaneous coronary intervention and is associated with a higher risk of adverse cardiovascular events both in the short-term and long-term. There are several modalities for modifying calcified plaque, such as balloon angioplasty (including specialty balloons), coronary atheroablative therapy (rotational, orbital, and laser atherectomy), and intravascular lithotripsy. We discuss each modality’s relative advantages and disadvantages and the data supporting their use. This review also highlights the importance of intravascular imaging to characterize coronary calcification and presents an algorithm to tailor the calcium modification therapy based on specific coronary lesion characteristics. Full article
(This article belongs to the Special Issue Novel Challenges and Advances in Complex Coronary Interventions)
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9 pages, 1472 KiB  
Review
Left Ventricular Unloading in Acute on Chronic Heart Failure: From Statements to Clinical Practice
by Alice Sacco, Nuccia Morici, Jacopo Andrea Oreglia, Guido Tavazzi, Luca Villanova, Claudia Colombo, Laura Garatti, Michele Giovanni Mondino, Stefano Nava and Federico Pappalardo
J. Pers. Med. 2022, 12(9), 1463; https://doi.org/10.3390/jpm12091463 - 6 Sep 2022
Viewed by 1702
Abstract
Cardiogenic shock remains a deadly complication of acute on chronic decompensated heart failure (ADHF-CS). Despite its increasing prevalence, it is incompletely understood and therefore often misdiagnosed in the early phase. Precise diagnosis of the underlying cause of CS is fundamental for undertaking the [...] Read more.
Cardiogenic shock remains a deadly complication of acute on chronic decompensated heart failure (ADHF-CS). Despite its increasing prevalence, it is incompletely understood and therefore often misdiagnosed in the early phase. Precise diagnosis of the underlying cause of CS is fundamental for undertaking the correct therapeutic strategy. Temporary mechanical circulatory support (tMCS) is the mainstay of management: identifying and selecting optimal patients through understanding of the hemodynamics and a prompt profiling and timing, is key for success. A recent statement from the American Heart Association provided pragmatic suggestions on tMCS device selection, escalation, and weaning strategies. However, several areas of uncertainty still remain in clinical practice. Accordingly, we present an overview of the main pitfalls that can occur during patients’ management with tMCS through a clinical case. This case illustrates the strict interdependency between left ventricular unloading and right ventricular dysfunction in the case of low filling pressures. Moreover, it further illustrates the pivotal role of stepwise escalation of therapy in a patient with an ADHF-CS and its peculiarities as compared to other forms of acute heart failure. Full article
(This article belongs to the Special Issue Novel Challenges and Advances in Complex Coronary Interventions)
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11 pages, 902 KiB  
Review
Ultrathin Struts Drug-Eluting Stents: A State-of-the-Art Review
by Attilio Leone, Fiorenzo Simonetti, Marisa Avvedimento, Domenico Angellotti, Maddalena Immobile Molaro, Anna Franzone, Giovanni Esposito and Raffaele Piccolo
J. Pers. Med. 2022, 12(9), 1378; https://doi.org/10.3390/jpm12091378 - 25 Aug 2022
Cited by 14 | Viewed by 6758
Abstract
New-generation drug-eluting stents (DESs) represent the standard of care for patients undergoing percutaneous coronary intervention (PCI). Recent iterations in DES technology have led to the development of newer stent platforms with a further reduction in strut thickness. This new DES class, known as [...] Read more.
New-generation drug-eluting stents (DESs) represent the standard of care for patients undergoing percutaneous coronary intervention (PCI). Recent iterations in DES technology have led to the development of newer stent platforms with a further reduction in strut thickness. This new DES class, known as ultrathin struts DESs, has struts thinner than 70 µm. The evidence base for these devices consists of observational data, large-scale meta-analyses, and randomized trials with long-term follow-up, which have been conducted to investigate the difference between ultrathin struts DESs and conventional new-generation DESs in a variety of clinical settings and lesion subsets. Ultrathin struts DESs may further improve the efficacy and safety profile of PCI by reducing the risk of target-lesion and target-vessel failures in comparison to new-generation DESs. In this article, we reviewed device characteristics and clinical data of the Orsiro (Biotronik, Bülach, Switzerland), Coroflex ISAR (B. Braun Melsungen, Germany), BioMime (Meril Life Sciences Pvt. Ltd., Gujarat, India), MiStent (MiCell Technologies, USA), and Supraflex (Sahajanand Medical Technologies, Surat, India) sirolimus-eluting stents. Full article
(This article belongs to the Special Issue Novel Challenges and Advances in Complex Coronary Interventions)
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14 pages, 288 KiB  
Review
Percutaneous Coronary Angioplasty in Patients with Cancer: Clinical Challenges and Management Strategies
by Gemina Doolub and Mamas A. Mamas
J. Pers. Med. 2022, 12(9), 1372; https://doi.org/10.3390/jpm12091372 - 25 Aug 2022
Cited by 4 | Viewed by 2388
Abstract
The number of cancer survivors in the United States is projected to increase by 31% by 2030. With advances in early screening, diagnosis and therapeutic strategies, a steadily increasing number of patients are surviving cancer. Coronary artery disease (CAD) is now one of [...] Read more.
The number of cancer survivors in the United States is projected to increase by 31% by 2030. With advances in early screening, diagnosis and therapeutic strategies, a steadily increasing number of patients are surviving cancer. Coronary artery disease (CAD) is now one of the leading causes of death amongst cancer survivors, with the latter group of patients having a higher risk of CAD compared to the general population. Our review covers a range of specific challenges faced by doctors when considering percutaneous coronary interventions (PCI) in cancer patients; clinical outcomes in cancer patients undergoing PCI, as well as some important technical considerations to be made when making decisions regarding the management strategy in this special population of patients. Full article
(This article belongs to the Special Issue Novel Challenges and Advances in Complex Coronary Interventions)
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