Background: Left ventricle (LV) assist devices may be required to stabilize hemodynamic status during complex, high-risk, and indicated procedures (CHIP). We present a case in which elective hemodynamic support with the Impella CP device was essential to achieve complete revascularization with PCI in a patient with complex multivessel disease and severely depressed LV function.

Case Summary: A 45-year-old male with no previous history of cardiovascular disease presented to the emergency department for new onset exertional dyspnoea. Echocardiography showed severely depressed LV function (EF 27%) that was confirmed with cardiac magnetic resonance. Two chronic total occlusions (CTOs) of the proximal right coronary artery (RCA) and left circumflex coronary artery (LCx) were found at coronary angiography. After Heart Team evaluation, PCI with Impella hemodynamic support was planned. After crossing and predilating the CTO of the LCx, ventricular fibrillation (VF) occurred. No direct current (DC) shock was performed because the patient was conscious thanks to the support provided by the Impella pump. About 1 min later, spontaneous termination of VF occurred. Afterwards, the two CTOs were successfully treated with good result and no complications. Recovery of LV function was observed at discharge. At 9 months, the patient had no symptoms and echocardiography showed an EF of 60%.

Discussion: In this complex high-risk patient, hemodynamic support was essential to allow successful PCI. It is remarkable that the patient remained conscious and hemodynamically stable during VF that spontaneously terminated after 1 min, likely because the Impella pump provided preserved coronary perfusion and LV unloading. This case confirms the pivotal role of Impella in supporting CHIP, particularly in patients with multivessel disease and depressed LV function.

背景：可能需要左心室 (LV) 辅助装置在复杂、高风险和指示性程序 (CHIP) 期间稳定血流动力学状态。我们介绍了一个案例，在该案例中，对于患有复杂多支血管疾病且左室功能严重低下的患者，使用 Impella CP 装置进行选择性血流动力学支持对于通过 PCI 实现完全血运重建至关重要。

案例摘要：一名 45 岁男性，既往无心血管疾病史，因新发劳力性呼吸困难到急诊科就诊。超声心动图显示 LV 功能严重下降（EF 27%），心脏磁共振证实了这一点。在冠状动脉造影中发现了近端右冠状动脉 (RCA) 和左回旋支冠状动脉 (LCx) 的两个慢性完全闭塞 (CTO)。在心脏团队评估之后，计划使用 Impella 血流动力学支持进行 PCI。在穿过并预扩张 LCx 的 CTO 后，发生了心室颤动 (VF)。由于 Impella 泵提供的支持，患者意识清醒，因此没有进行直流 (DC) 电击。大约 1 分钟后，室颤发生自发终止。然后，两位CTO均获得成功治疗，效果良好，无并发症。出院时观察到左室功能恢复。9 个月时，患者没有任何症状，超声心动图显示 EF 为 60%。

讨论：在这个复杂的高危患者中，血流动力学支持对于成功进行 PCI 至关重要。值得注意的是，患者在 1 分钟后自发终止的 VF 期间保持清醒和血流动力学稳定，这可能是因为 Impella 泵提供了保留的冠状动脉灌注和 LV 卸载。该病例证实了 Impella 在支持 CHIP 中的关键作用，特别是在多支血管疾病和 LV 功能低下的患者中。