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Mohamed Ayoub: LIAB post CABG mit Impella
1. Within the past 12 months, I or my spouse/partner have had a
financial interest, arrangement, or affiliation with the
organization(s) listed below:
LIAB Post CABG with Impella
Mohamed Ayoub
Director CHIP and CTO Program
University Heart Center Bad Oeynhausen
2. Within the past 12 months, I or my spouse/partner have had a
financial interest, arrangement, or affiliation with the
organization(s) listed below:
Within the past 12 months, I or my spouse/partner have had a
financial interest, arrangement, or affiliation with the
organization(s) listed below:
Affiliation/Financial Relationship
Consultant, Proctor
Company
BostonScientific,Tel
eflex, Asahi intecc,
Cordis, Terumo
Disclosures
3. Post-CABG CTOs are the most complex CTO
scenarios
• Severe native vessel disease
• Anatomical ambiguity and graft anastomosis changing the vessel
route
• Extensive fibrosis/calcification
• Narrow landing zone
• LIMA as the last remaining patent graft
7. History
• 76-year-old male with known coronary artery disease
• History of CABG (LIMA to LAD, SVG to CX-PL, SVG to Dg) 2008
• Patient referred to our centre for PCI of SVG to RCA or CTO PCI of RCA
• Ejection fraction 37% with preserved viability in MRI
• Clinical presentation: persistent dyspnoea NYHA II
21. Outcome
• Patient transferred to the ICU with Impella CP
• CT- scan showed large myocardial hematome
• 15l volume were transferred during 48 hours
• Impella weaned after 72 hours
• Patient discharged at day 7
22. Learning objective 1
Troubleshooting algorithm of uncrossable lesion during CTO:
Increase support
Power-knuckle
Modified Carlino Technique
Laser
External crush
Rotational atherectomy
23. Learning objective 2
Rotational atherectomy in the subintimal space
in CTO PCI:
• Small burr (1.25mm)
• Conventional speeds (160.000 to 180.000 rpm)
• Rota wire needs to be within the vessel
architecture
24. Learning objective 3
Perforation in Post CABG CTO PCI:
1. Prepare coils, covered stents, ping-pong technique etc.
2. Notify the surgeon
3. Treat early
4. Impella supprt might be helpful