Questions / Answers from July 21, 2009 Case
Questions / Answers from Case
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Is the Impella 5.0 available yet? If so, what will the criteria be whether you would use a 2.5 versus a 5.0? Have you put peclose device already or you will put later for Ampala closure? |
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Impella 5.0 is a 19Fr device and is used during CT surgery and requires open cut down of the vessel while Impella 2.5 is a 13Fr device and 2 Preclose sutures are required for vascular hemostasis (or some times manual compression). |
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In a complicated case or if pt is crashing due to Cardiogenic shock, have you ever put Impala emergently like IABP |
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Yes. Impella can be used during cath lab catastrophe just like IABP. We have had experience of one case of this kind so far. |
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Do you always place 2nd wire along side Rota wire as your standard , technique to bring balloon or stent to vessel rather than exchange, Rota wire? |
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Yes. The Rota wire does not give good support to advance the interventional devices. If there is dissection after Rota then over the wire balloon should be advanced over the Rota wire and exchanged with a 300cm workhorse wire (BMW etc). |
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Have you stopped your anticoagulant and what is your target ACT at this point? |
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Heparin or Angiomax is stopped when we start weaning the Impella device towards end of the PCI. During the procedure ACT should be >300sec. |
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What is the use of Impella in RVMI? |
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Limited data are available for Impella in RVMI and theoretically it probably will not be effective in this setting. |
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What is the advantage of Impella over IABP? |
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While IABP provides only 0.5L/min of CO, Impella provides 2.5L/min of Cardiac output. |
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Are you worried about wire jailing in side branch which wire was in diagonal? |
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Any wire (hydrophilic or otherwise) can be jailed in the side branch. This particular case we had Fielder wire from Abbott Inc in the Diagonal. |
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Have you put Preclose device already or you will put later for Impella closure? |
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Yes. Preclose sutures are applied on a 8fr sheath before the 13Fr sheath insertion. |
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