MoyoAssist® Facilitates Safe and Complete CHIP-PCI in Patient with Heart and Renal Failure

A multidisciplinary cardiovascular team at Nanjing First Hospital (Nanjing Medical University Affiliated Nanjing Hospital) successfully utilized the MoyoAssist® extracorporeal VAD to support a high-risk PCI procedure in a patient with severe heart failure and end-stage renal disease. This case illustrates the clinical utility of Extra VAD in maintaining hemodynamic stability during complex revascularization and supporting postoperative recovery in a multi-morbid CHIP patient.

Patient Profile

Key Clinical Findings:

Lab Tests: Severe renal dysfunction (Cr 696.6 μmol/L, eGFR 7.5 ml/min), anemia (Hb 82 g/L), severe cardiac dysfunction (NT-proBNP >35,000 pg/ml), dyslipidemia (HDL 0.58 mmol/L)

ECG: Sinus rhythm with ventricular premature beats, LV hypertrophy, and ischemic changes

CAG: Severe multi-vessel disease including calcified LM bifurcation lesions and diffuse RCA plaques

Echo: LVEF 36%, biatrial enlargement, moderate mitral/tricuspid regurgitation, PASP ~83 mmHg

CT: Bilateral pleural effusion and pulmonary edema

CTA: Abdominal aortic calcification and peripheral vascular abnormalities

Diagnosis

• Coronary artery disease (OMI , multi-vessel + LM bifurcation)

• NYHA Class IV heart failure (EF 36%)

• Severe pulmonary hypertension

• Type 2 diabetes, hypertension

• End-stage renal disease (on dialysis)

• Anemia

Interventional Strategy

This patient presented with multiple risks: extensive coronary disease involving the LM and LAD/D1 bifurcations, heavy calcification, severely reduced LVEF, pulmonary hypertension, and dialysis-dependent kidney failure. Standard PCI carried an unacceptably high risk of intra-procedural circulatory collapse.

A multidisciplinary team (Cardiology, ICU, Anesthesiology, Cardiac Surgery, and Nephrology) decided on a “Single-Session CHIP-PCI under MoyoAssist® support” strategy, prioritizing real-time circulatory stabilization during the intervention. The plan involved:

• Establishing extracorporeal hemodynamic support with MoyoAssist® before PCI

• Performing complex PCI 

• Continuing dialysis post-op to maintain metabolic stability

Procedure Highlights

The team performed the procedure under continuous extracorporeal VAD support:

1. MoyoAssist® Cannulation

• Trans-septal puncture guided by TEE

• Venous cannula placed via right femoral vein into the left atrium; arterial return via left femoral artery

• Real-time pulmonary artery pressure monitoring via Swan-Ganz catheter during opration

2.  PCI Execution

• Three guidewires advanced into LAD, D1, and LCX

• Sudden interruption of blood flow happens to LAD during wire crossing, but MoyoAssist® preserved stable MAP (~70 mmHg) throughout

• IVUS confirmed 270° calcification in LAD; lesion pre-dilated using shockwave balloon (3.5 mm, 80 pulses)

3.  Complex Bifurcation Strategy

• DEFINITION criteria confirmed complex LM and LAD/D1 bifurcations, two DK CRUSH techniques performed consecutively

• During balloon post-dilation at LM bifurcation, heart rate dropped from 70 to 45 bpm, but stable perfusion via MoyoAssist® enabled completion of stenting without hemodynamic compromise

  
  

4. Final Result

• Angiography showed TIMI 3 flow with excellent result

• IVUS confirmed stent expansion met ULTIMATE criteria

Post-Procedure Recovery

The patient remained hemodynamically stable post-operatively without arrhythmia or worsening heart failure. After 24 hours, vasoactive agents were tapered off. NT-proBNP dropped significantly, and bedside echocardiography indicated improved function. Renal function was maintained with continued dialysis. After one week of optimized GDMT, the patient was safely discharged.

Clinical Reflectiony

This case represented a convergence of multiple high-risk factors—LM bifurcation, multi-vessel disease, severe calcification, poor cardiac function, pulmonary hypertension, and end-stage-renal disease under these conditions. Routine PCI would likely have led to catastrophic hemodynamic instability.

MoyoAssist® provided essential intraoperative advantages:

• Hemodynamic Stabilization: Maintained perfusion during interruption of LAD flow and tachycardia

• Cardiac Unloading: Reduced myocardial oxygen consumption and enabled post-op recovery

• Multisystem Compatibility: Integrated seamlessly with renal dialysis management