Mr. Gonzalez is scheduled to undergo a percutaneous coronary intervention (PCI) procedure. He asked his doctor to explain what will happen during and after the procedure. He was given the following explanation:
The Protected PCI procedure is performed in a cardiac catheterization laboratory (cardiac cath lab), which contains the computerized X-ray equipment needed to perform the procedure.
BEFORE your Protected PCI Procedure
A heart team of doctors, including a cardiac surgeon, has determined that you are not a candidate for cardiac surgery (CABG) due to the risks involved, but that PCI is the appropriate therapeutic option for you. In addition, it has also been determined that your specific condition may benefit from the use of the Impella® 2.5 System to help maintain heart function during the Protected PCI procedure. Before the Impella 2.5 is inserted into your heart, your doctor will review your medical information with you or a family member to make sure the Impella 2.5 is right for you. Your doctor may also perform a test—using sound waves to look at your heart and blood vessels—to make sure you can use the Impella 2.5 safely.
DURING your Protected PCI Procedure
On the day of your procedure, you will arrive at the hospital, change into a hospital gown and walk into the cardiac cath lab. Your vital signs will be monitored and you will be given an intravenous (IV) line for fluids and medicines. For your comfort, you will be sedated but most likely awake during the procedure. You will receive fluids, medications to relax you and blood-thinning medications (anticoagulants).
At the beginning of the procedure, your doctor will numb your leg so no pain is felt when the Impella 2.5 Catheter is inserted. The catheter will be inserted into your femoral artery through a small incision in your leg. Then it will be advanced through the artery to your heart. A series of x-rays will be taken to help position the device. The catheter will be connected to the console and the pump will be turned on.
Once the Impella 2.5 Catheter is placed and operating, the PCI procedure continues. Once the blockages in your coronary arteries are located, a procedure will be performed to open the blockages. A catheter is placed at the location of the blockage and a small balloon at the end of the catheter is inflated, widening the blocked artery. This procedure is called balloon angioplasty. After the artery is stretched, the balloon is deflated and removed.
Your doctor might inflate and deflate the balloon several times before it’s removed, stretching the artery a bit more each time. If you have several blockages, the procedure may be repeated at each blockage.
People who have balloon angioplasty usually also have one or more stents placed in their blocked coronary arteries. The stent is usually inserted in the artery once it is widened by the inflated balloon. The stent supports the walls of your artery to help prevent it from re-narrowing after the angioplasty procedure. The stent looks like a tiny coil of wire mesh.The procedure is usually completed in one or more hours, depending on the number of blood vessels treated.
AFTER your Protected PCI Procedure
If the functioning of your heart is stable after the HRPCI procedure, your doctor will remove the Impella® 2.5 Catheter and you will be moved to a recovery room or coronary care unit (CCU). If your heart continues to need support after the procedure, your doctor may leave the Impella 2.5 Catheter in place until your condition stabilizes.
When your condition is stabilized, your doctor will remove the Impella 2.5 Catheter and the small hole in your femoral artery will be closed and bandaged. You may experience some pain from the surgical incisions that were part of the medical procedure of putting in the Impella 2.5 Catheter. Your medical team will give you medication for your heart and pain medication as necessary.
The average hospital stay after an uncomplicated Protected PCI procedure is 1 to 2 days. You will probably be able to start walking 12 to 24 hours after surgery. Depending upon the judgment of your doctors, you may be able to resume exercise and driving a few days after you are discharged from the hospital. Due to the stent placement in your coronary arteries, you will be prescribed anti-platelet medication to reduce the risk of the stent clotting over time.
At your follow up visit the doctor will examine you and determine your progress. The doctor may suggest a stress test or cardiac rehabilitation and exercise program. Exercise, and other lifestyle changes may lower the risk of additional coronary artery disease and repeat procedures.
Learn more about PCI and Protected PCI. For more information about the Impella 2.5’s approved indications for use, as well as important safety, contraindication and warning information concerning the device, please visit http://abiomed.com/impella.
- Learn more about treatment options for complex heart disease and heart failure.
- Find out how you can talk with your cardiologist and discover if Protected PCI is right for you.
- Watch our patient stories to learn how Protected PCI with Impella has helped qualified heart patients.
The Impella 2.5 system is a temporary (<6 hours) ventricular support device indicated for use during high risk percutaneous coronary interventions (PCI) performed in elective or urgent, hemodynamically stable patients with severe coronary artery disease and depressed left ventricular ejection fraction, when a heart team, including a cardiac surgeon, has determined high risk PCI is the appropriate therapeutic option. Use of the Impella 2.5 in these patients may prevent hemodynamic instability which can result from repeat episodes of reversible myocardial ischemia that occur during planned temporary coronary occlusions and may reduce peri- and post-procedural adverse events.
Protected PCI and use of the Impella 2.5 is not right for every patient. Patients may not be able to be treated with Impella if they have certain pre-existing conditions, which a cardiologist can determine, such as: severe narrowing of the heart valve, severe peripheral artery disease, clots in blood vessels, or a replacement heart valve or certain heart valve deficiencies. Additionally, use of Impella has been associated with risks, including, but not limited to valvular and vascular injury, bleeding, and limb ischemia in certain patients. Learn more about the Impella devices’ approved indications for use, as well as important safety and risk information at www.protectedpci.com/indications-use-safety-information/.