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Bifurcation lesions, especially around the left main coronary (LMC), are occasionally encountered. More frequent LMC lesion are present in Complex and High risk Patients (CHIP) and this case represent a real challenge for interventional cardiologists. Bifurcation lesions PCI reported to have high overall major adverse cardiovascular events, and require the use of various complex interventional techniques. Here, we report a case of successful percutaneous coronary intervention supported by Impella on an LMC bifurcation treatment with culotte stenting in patient with cardiogenic shock.

Background: Heart failure is an epidemic affecting over 6 million people in the United States. Eighty percent of all heart failure patients are older than 65 years of age. Heart transplant is the gold standard treatment for patients suffering advanced heart failure, but only 18.5% of patients receiving heart transplant in the United States are 65 years of age or older. Continuous‐flow left ventricular assist devices are a safe and effective therapy for patients with advanced heart failure, and can be used to bridge patients to a heart transplant or to support patients long‐term as destination therapy. Material and Methods: We sought to characterize long‐term outcomes of elderly patients receiving continuous‐flow left ventricular support in our program. Conclusion: Elderly patients with advanced heart failure presented comparable operative results to those of younger patients. The rate of complications up to 6 years of support was low, and comparable to those of younger patients. An effective and safe alternative for patients whom are less likely to receive heart transplantation. [ABSTRACT FROM AUTHOR]

Objectives. The presence of a mechanical prosthesis has been regarded as an increased risk of thromboembolic complications and as a relative contraindication for a left ventricular assist device (LVAD). Five patients in our center had a mechanical aortic valve at the time of device implantation and were studied regarding thromboembolic complications. Design. Five patients operated upon with an LVAD (1 HeartMate I™, 4 HeartMate II™) between 2002 and 2011 had a mechanical aortic valve at the time of implantation. The first patient had a patch closure of the aortic valve. In four patients, the prosthesis was left in place. Anticoagulants included aspirin, warfarin, and clopidogrel. Results. The average and accumulated treatment times were 150 and 752 days, respectively. Three of the five patients showed early signs of valve thrombosis on echo with concomitant valve dysfunction. Four patients were transplanted without thromboembolic events during pump treatment. One patient died from a hemorrhagic stroke after 90 days on the LVAD. Conclusions. The strategy of leaving a mechanical heart valve in place at the time of LVAD implantation in five patients led to valvular thrombosis in three but did not provoke embolic events. It increased the complexity of postoperative anticoagulation. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 53-year-old man having ischaemic dilated cardiomyopathy with a left ventricular ejection fraction (LVEF), which was treated with world's first insertion of 8 Fr 50 cc Intra-Aortic Balloon (IAB) catheter. It states that The IAB catheter was used in conjunction with the CardioSave IABP hardware.

The article discusses Fiber-optic intra-aortic balloon therapy and its role within cardiac surgery, where it states that Fiber-optic manometers provide accurate and fast, high quality measurements. It also mentions effect of fiber-optic IABP therapy on clinical management. It is concluded that Fiber-optic IAB technology and improved algorithms provide better beat per beat mechanical support.

Abstract: Background: Temporary use of a percutaneous left ventricular assist device (PLVAD) may be beneficial in patients undergoing high-risk percutaneous coronary intervention (PCI) and those with cardiogenic shock (CS). Methods: Seventy-four consecutive patients undergoing high-risk PCI and those with CS receiving intraaortic balloon pump (IABP), TandemHeart (TH), or Impella device (IMP) were enrolled. Patient undergoing high-risk PCI (n=57) and those treated for CS (n=17) were analyzed as separate cohorts. Patients undergoing IABP-assisted PCI were compared to those undergoing PLVAD (TH and IMP)-assisted PCI. The primary end point was in-hospital major adverse cardiovascular events, and the secondary end point was in-hospital vascular complications. Results: For the high-risk PCI cohort (n=57), 22 received PLVAD and 35 received IABP. Patients receiving IABP were younger and less likely to have a prior myocardial infarction (MI) and less likely to be on dialysis compared to those receiving PLVAD support. Patients receiving PLVAD support had a higher baseline Syntax score, had a higher prevalence of unprotected left main disease, underwent treatment of more coronary lesions, received more coronary stents, and more likely received drug-eluting stents compared to those receiving IABP support. The primary and secondary end points were similar between both groups. For the CS cohort (n=17), 4 received PLVAD and 13 received IABP. Patients receiving PLVAD support were more likely to have a prior MI, had a lower ejection fraction, underwent treatment of more coronary lesions, and received more coronary stents compared to those receiving IABP support. The primary and secondary end points were similar between both groups. Conclusions: IABP compared with PLVAD use for high-risk PCI and CS is associated with significantly different baseline patient, clinical, procedural, and angiographic characteristics. In-hospital clinical outcome was similar between both groups in both the high-risk PCI and the CS cohorts. When physicians have access to each of these devices, short-term clinical outcome appears to be similar. [Copyright &y& Elsevier]

The treatment of refractory terminal heart failure has been heart transplantation. However, there are limitations with regard to clinical conditions of the recipient and availability of donors, and ventricular support has therefore been alternatively used as destination therapy. We describe the case is of a female patient with ischemic cardiomyopathy-associated heart failure who had a left ventricular assist device successfully implanted and at eight months of the procedure was at functional class I, with no complications., (Copyright: © 2019 SecretarÍa de Salud.)