ABSTRACT
Introduction:
Recently published studies suggest that
percutaneous coronary intervention (PCI) has no significant impact on outcomes in
patients with
heart failure and stable
coronary artery disease. The use of percutaneous mechanical circulatory support is growing, but its value is still uncertain. If large areas of viable
myocardium are ischemic, the benefit from revascularization should be evident. In such instances, we should strive for complete revascularization. The use of mechanical circulatory support in such cases is vital because it provides
hemodynamic stability throughout the complex
procedure. Case
report We present a case of a 53-year-old
male heart transplant candidate with
type 1 diabetes mellitus, initially considered unsuitable for revascularization and qualified for
heart transplantation, transferred to our center due to acute decompensated
heart failure. At this
time, the
patient had temporary
contraindications for
heart transplantation. As the
patient was considered no-option, we have decided to reassess the possibility of revascularization. The
heart team opted for a high-
risk mechanically supported PCI with the aim of complete revascularization. A complex multivessel PCI was performed with optimal effect. The
patient was weaned off
dobutamine on the second day post-PCI. Four months post-discharge, he remains stable, is in NYHA II class, and has no
chest pain. Control
echocardiography showed improved ejection fraction. The
patient is not a
heart transplant candidate anymore.
Conclusions:
This case
report shows that we must strive for revascularization in select
heart failure cases. The outcome of this
patient suggests that
heart transplant candidates with potentially viable
myocardium should be considered for revascularization, especially as the shortage of
donors persists. In the most complex coronary
anatomy and severe
heart failure, mechanical support in the
procedure might be essential.