Heart Disease & Heart Failure

What to Expect Before, During and After a High-Risk PCI Procedure

BEFORE Your Protected PCI Procedure

A team of heart doctors, including a cardiac surgeon, has determined that you are not a candidate for coronary artery bypass graft (CABG) surgery due to the risks involved, but that high-risk PCI is the appropriate therapeutic option for you. In addition, it has also been determined that your specific condition may benefit from use of the Impella® heart pump to maintain heart function during the high-risk PCI procedure making it a Protected PCI. Before the Protected PCI procedure with Impella, your doctor will review your medical information with you or a family member to make sure the Impella heart pump is safe and the right option for you. Your doctor may also perform a test - using sound waves to look at your heart and blood vessels - to make sure that Impella can be used safely and effectively during the PCI.

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 help you relax and blood-thinning medications (anticoagulants).

At the beginning of the procedure, your doctor will numb your leg so you don't feel pain when the Impella heart pump is inserted. The heart pump 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 pump. Once it's in the correct position, the pump will be turned on.

At this time, the PCI procedure will continue. Once the blockages in your coronary arteries are located, a procedure will be performed to open the blockages. A heart pump is placed at the location of the blockage and a small balloon at the end of the heart pump 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 requiring treatment.

AFTER Your Protected PCI Procedure

If your heart function is stable after the high-risk PCI procedure, your doctor will remove the Impella heart pump and you will be moved to a recovery room or coronary care unit (CCU). If after the PCI your heart requires additional support, your doctor may leave the Impella heart pump in place until your condition stabilizes. 

When your condition is stabilized, your doctor will remove the Impella heart pump 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 heart pump. 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 one to two days. You will likely be able to start walking 12 to 24 hours after the procedure. Depending upon the clinical 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.

During your follow-up visit, your doctor will do a physical exam to help determine your progress post-procedure. Your doctor may suggest a stress test, cardiac rehabilitation or recommend an 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 heart pump's approved indications for use, as well as important safety, contraindication and warning information concerning the device, please visit http:/abiomed.com/impella.

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