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Pulsatile iVAC 2L circulatory support in high-risk percutaneous coronary intervention

Selected in EuroIntervention by S. Brugaletta

References

Authors

den Uil CA, Daemen J, Lenzen MJ, Maugenest AM, Joziasse L, van Geuns RJ, Van Mieghem NM

Reference

EuroIntervention. 2017 Feb 20;12(14):1689-1696

Published

February 2017

Link

Read the abstract

My Comment

What is known 

Catheter-based circulatory support devices can be used to prevent or stabilise haemodynamic compromise in patients undergoing high-risk percutaneous coronary interventions (PCI). The benefit of circulatory support in high-risk PCI is unproven, yet use of the intra-aortic balloon pump (IABP) enhances haemodynamic stability and the Impella 2.5 provides even superior haemodynamic support.
However, especially in cardiogenic shock from acute myocardial infarction, the benefit of the IABP on global haemodynamics and tissue perfusion has recently been questioned. Guidelines on myocardial revascularisation provide prudent recommendations on the use of circulatory support with PCI.
The PulseCath iVAC 2L® (PulseCath B.V., Amsterdam, The Netherlands) is a next-generation pulsatile support system driven by any standard IABP console and generating pulsatile blood flow up to 2 L/min, depending on preload and afterload conditions and heart rate. The aim of this pilot study was to assess the feasibility and safety of iVAC 2L circulatory support in patients undergoing elective high-risk PCI. 

Major findings 

  • 14 patients who underwent high-risk PCI under protection with the iVAC 2L were enrolled.
  • Median age was 74 (56-84) years.
  • Implantation of the iVAC 2L was successful in 13 (93%) patients. Median device flow was 1.4 (1.1-2.0) L/min. Total support time was 67 (23-149) minutes.
  • The use of iVAC 2L support was associated with a better mean arterial pressure and cardiac output during the procedure. Angiographic success was 100%.
  • There was one major procedural complication related to the 19 Fr. access sheath. There were no major adverse events at three-month follow-up. 

My comment

The use of catheter-based circulatory support devices has always captured the interest of interventional cardiologists, because they represent useful devices in particular clinical conditions, and because they are not easy to use. They require indeed the use of large and big sheath, and specific knowledge on how to use it and how to prevent complications.
To this aim, new devices that are easier to use, more effective and with smaller sheath are very welcome.
In this article the iVAC 2L device is presented as safe and effective with only one major complication related to the 19Fr. access sheath. A comparative trial with other devices available would be worthy.

How many of you are familiar with these catheter-based circulatory support devices? Which one do you use in your practice and in what clinical scenario?

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