Use of pulmonary artery catheters during ImpellaTM-protected high risk percutaneous coronary intervention: a single centre experience

ImpellaTM is a trans-aortic microaxial-pump which provides temporary mechanical circulatory support during High Risk-Percutaneous Coronary Intervention (HR-PCI). The use of pulmonary artery catheters (PAC) in this setting can aid in patient selection, provide closer haemodynamic monitoring and guide device weaning but its routine use is debated.

We sought to review our local experience of PAC use during HR-PCI.

A retrospective analysis of consecutive ImpellaTM-protected-HR-PCI since 2018 at Liverpool Hospital was performed with patient and procedural characteristics and in-hospital outcomes reviewed.

36 patients (median age 69 years, 27 men) undergoing HR-PCI for 100 lesions were reviewed. Median LVEF was 33% (IQR26.8-40%). Complex lesion characteristics and diabetes were common (Table 1). Procedural success was high 94%. 5 lesion failures were chronic total occlusions (CTO). Ventriculo-arterial uncoupling was reported in 7/36 (19%) and loss-of-pulsatility in 4 (11.1%) cases. PAC was not used before 2022 (19 patients) and in 11 of 17 (65%) patients since. Median right atrial pressure was 6.5mmHg (IQR5.25-12.5), mean pulmonary artery pressure (mPAP) was 26mmHg (IQR19-33), pulmonary capillary wedge pressure (PCWP) 14.5mmHg (IQR11.75-19.75) and pulmonary vascular resistance 1.4WU (IQR 1.1-3.3). Median Cardiac Index was 2.5L/min/m2(IQR2-3), cardiac power output (CPO) 0.98W (IQR0.6-1.1) and pulmonary artery pulsatility index 2.8 (IQR1.35-3.8). ImpellaTM was successfully weaned on-table in all 25 patients without PAC (one subsequent death) and in 9 with PAC. Weaning was delayed in 2 patients due to reduced CPO and increasing mPAP and PCWP (one died subsequently). 34 survived (94.4%) to discharge [median 5 days (IQR 1-11 days)].

Our ImpellaTM-protected-HRPCI experience exhibits high procedural success and low complication rates with increasing PAC use. PAC derived haemodynamic data may be useful in assisting with device weaning and explant. This will be further studied in Protect-IV.For image description, please refer to the figure legend and surrounding text.