A Case Report: Use of Ventricular Assist Device to Enable High-Risk PCI in a Patient with Severe Left Ventricular Dysfunction

Recently, at Beijing Luhe Hospital, Capital Medical University, a high-risk PCI was performed on a patient with the support of MoyoAssist®, a temporary Ventricular Assist Device. The patient had severely impaired cardiac function and complex left main coronary occlusion, presenting an exceptionally high procedural risk. Following a comprehensive preoperative evaluation, the team elected to perform a high-risk PCI under hemodynamic support from the MoyoAssist® Extra VAD. This approach ensured hemodynamic stability during the critical stages of revascularization, enabling successful complete coronary revascularization.

Patient Profile:

• Age: 63 

• Gender: Male 

• Medical History: Unstable angina; Coronary artery disease; Heart failure (NYHA Class III); Severe mitral regurgitation; Moderate-to-severe tricuspid regurgitation; Reflux esophagitis; Hyperlipidemia (suboptimal controlled with statins). 

• Symptoms: Chest tightness for 20 days.

Key Findings:

• Echocardiography indicated an enlarged left ventricle, mildly enlarged right atrium, segmental wall motion abnormalities, a left ventricular apical aneurysm, and significantly reduced left ventricular function with an LVEF of 27%. 

• Doppler findings included severe mitral regurgitation (area 9.3cm²), moderate-to-severe tricuspid regurgitation (area 5.1cm²), mild aortic regurgitation, and elevated pulmonary artery systolic pressure. Left ventricular end-diastolic diameter was 66mm. 

• Coronary angiography revealed a proximal occlusion of the left main (LM) coronary artery and diffuse mild disease in the right coronary artery (RCA), with retrograde filling of the left anterior descending (LAD) and left circumflex (LCX) arteries from the RCA.

Chest X-ray:

Diagnoses:

• Coronary artery disease, unstable angina 

• heart failure, NYHA Class III 

• Severe Mitral Regurgitation 

• Moderate-to-severe Tricuspid Regurgitation 

• Reflux Esophagitis 

• Hyperlipidemia

Procedure Strategy:

• The patient was considered high-risk for conventional surgery due to severely impaired left ventricular function (LVEF 27%) and comorbidities. 

• PCI was planned, but procedural risks such as hemodynamic collapse and no-reflow were high due to the complexity of the lesion (LM occlusion) and the potential need for advanced techniques. 

• The clinical team decided to perform the PCI with hemodynamic support from the MoyoAssist® to ensure patient safety and provide an adequate time window for the intervention.

Preoperative LM angiography showed proximal LM occlusion.	Retrograde technique was used
Angiography after successful recanalization of LAD and LCX	Post-stenting angiography

Postoperative Course:

• The MoyoAssist® was implanted percutaneously. A 21F venous drainage cannula was placed in the left superior pulmonary vein via a transseptal approach, and a 17F arterial perfusion cannula was placed in the femoral artery. A distal perfusion cannula was also placed to ensure limb perfusion. 

• The device was initiated with a flow rate of 2L/min, maintaining stable hemodynamics. 

• The PCI procedure successfully revascularized the LM, LCX, and LAD arteries using Side-BASE, retrograde wire, and kissing wire techniques. 

• Intravascular ultrasound (IVUS) was used to guide stent placement, achieving complete revascularization and restoring TIMI 3 grade coronary flow.

•  The patient's vital signs remained stable throughout the procedure while supported by MoyoAssist®. 

• Post-procedure, the patient was transferred to the CCU with the device in place and experienced a smooth recovery.

Clinical Insights:

• The case demonstrates that for patients with severe heart failure and complex coronary artery disease, the MoyoAssist® provides effective hemodynamic support during high-risk PCI, a scenario where there is a significant risk of hemodynamic collapse. 

• This technology may offer a more optimal choice for mechanical circulatory support compared to an Intra-Aortic Balloon Pump (IABP) in extremely high-risk cases where limited hemodynamic improvement is insufficient. 

• By unloading the left ventricle, the device reduces myocardial oxygen consumption, which can create favorable conditions for post-procedural cardiac function recovery. 

• The clinical value of this technology in treating critically ill cardiovascular patients and providing short-to-medium term circulatory support for end-stage heart failure requires further validation through accumulated clinical experience.