Lots of interesting abstracts and cases were submitted for TCTAP 2022. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!
TCTAP C-075
How a Temporary LV Assist Device Helped to Bail Out a Patient in Cardiogenic Shock with Multiple Comorbidities
By Siddharth Bajaj, Anuj A. Kapadia
Presenter
Siddharth Bajaj
Authors
Siddharth Bajaj1, Anuj A. Kapadia2
Affiliation
Apollo Hospitals, India1, Care Hospitals, India2,
View Study Report
TCTAP C-075
CORONARY - Complex and Higher Risk Procedures for Indicated Patients (CHIP)
How a Temporary LV Assist Device Helped to Bail Out a Patient in Cardiogenic Shock with Multiple Comorbidities
Siddharth Bajaj1, Anuj A. Kapadia2
Apollo Hospitals, India1, Care Hospitals, India2,
Clinical Information
Patient initials or Identifier Number
GD
Relevant Clinical History and Physical Exam
- A 69-year-old gentleman, with history of diabetes, hypertension, post-liver transplantation, with complaints of chest pain, presented in cardiogenic shock.
- ECG: Left Bundle Branch Block.
- Echo-Global LV Hypokinesia with Severe Left Ventricular Dysfunction.
Relevant Test Results Prior to Catheterization
- Elevated troponin revealed Non-STEMI as a cause of decompensation. He was started on dual antiplatelets with heparin. Despite maximum possible medical management, two days later, the patient's renal parameters, acidosis and shock worsened and ionotropic requirement increased.
- Hence taken up for emergency CAG.
Relevant Catheterization Findings
- Patient was dialysed and posted for a coronary angiogram. Coronary angiography revealed heavily calcified LMCA, LAD and LCX with a tubular ostio-proximal disease of 90% in LCX (3.5 mm Vessel) and LAD, and 90% calcified stenosis in distal RCA with a syntax II score of 58.3 for PCI and 48.1 for CABG. Due to diffuse calcified vessels and absence of targets for CABG and multiple comorbities, multi-vessel PCI was planned with temporary LV assist device (Impella) support.
My Movie 4.mp4Interventional Management
Procedural Step
- PCI was performed with Impella support in the P9 mode with 5 minutes of boost mode used while performing rotablation during left main bifurcation stenting and final kissing balloon inflation.
- RCA was intervened first, with predilation with a 2.5 x 12 mm NC balloon, PTCA was done with a 3.5 x 16 mm Boston Scientific Synergy stent.
- PCI to LAD and LCX was done with rotablation assistance to LCX and LAD, using the DK crush method. After LCX was stented with a 3.5 x 28 mm Synergy stent, mid-LAD was stented with a 2.5 x 16 mm Synergy stent and thereafter LMCA-LAD was stented with a 3.5 x 28 mm Synergy stent.
- After the final rePOT to the stent in the LMCA -LAD, IVUS run showed well expanded stent with no dissection. Distal LAD MLA was 4.71 mm2 , Proximal LAD MLA was 7.9 mm2 , Proximal LCX MLA - 8.71 mm2, LMCA - MLA was 13.35mm2 .
- Post-procedure, the patient's heart failure signs got better, acidosis settled, creatinine and urine output improved and AKI resolved. 5 days later, the patient was dialysis-free and was discharged in a hemodynamically stable condition.
My Movie 7.mp4 My Movie 5.mp4 My Movie 6.mp4Case Summary
- This case demonstrates:
- The importance of temporary LV assist device (Impella) in a complex high-risk intervention with heavily calcified triple vessel disease with underlying cardiogenic shock and multiple comorbities.
- The use of DK crush method in a true bifurcation lesion with significant disease in large side branch.