Key result
Elective LV unloading reduces inotrope needs but increases pulse pressure loss during complex PCI.
Why the study?
Does elective left ventricular unloading with a microaxial flow pump reduce hemodynamic instability and postprocedural stunning in patients with severe LV systolic dysfunction undergoing complex PCI?
RCT (n=97)
randomized
Does elective left ventricular unloading with a microaxial flow pump reduce hemodynamic instability and postprocedural stunning in patients with severe LV systolic dysfunction undergoing complex PCI?
Answers are grounded in this paper and cite their sources.
In patients with severe LV systolic dysfunction undergoing complex PCI, elective LV unloading with a microaxial flow pump reduces inotrope requirements but increases loss of pulse pressure and does not prevent myocardial stunning.
BACKGROUND: Elective left ventricular (LV) unloading during high-risk percutaneous coronary intervention (PCI) is hypothesized to mitigate hemodynamic instability and myocardial stunning, but has not been evaluated in a randomized trial. OBJECTIVES: This prespecified substudy of the CHIP-BCIS3 (Controlled Trial of High-risk Coronary Intervention With Percutaneous Left Ventricular Unloading) trial evaluated whether elective LV unloading with a microaxial flow pump (mAFP) reduces hemodynamic instability and postprocedural stunning. METHODS: Patients with severe LV systolic dysfunction undergoing complex PCI were randomized to elective LV unloading with an mAFP or standard care. Invasive hemodynamics were assessed using pulmonary artery catheterization at baseline and post-PCI. The coprimary outcomes were systolic blood pressure reduction, loss of pulse pressure (LOPP), and requirement for inotropes. Secondary outcomes included changes in cardiac index, LV filling pressure, and frequency of peri-procedural myocardial injury. RESULTS: Of 125 eligible patients, 97 were enrolled (50 mAFP; 47 standard care). Baseline cardiac index was 2.10 ± 0.55 L/min/m CONCLUSIONS: In patients undergoing complex PCI, elective LV unloading with mAFP reduced inotrope requirements but increased LOPP and did not prevent myocardial stunning. (Controlled Trial of High-risk Coronary Intervention With Percutaneous Left Ventricular Unloading [CHIP-BCIS3]; NCT05003817).
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Ezad et al. (2026) conducted an RCT in Severe LV systolic dysfunction undergoing complex PCI (n=97). Elective LV unloading with a microaxial flow pump (mAFP) vs. Standard care was evaluated on Systolic blood pressure reduction, loss of pulse pressure (LOPP), and requirement for inotropes. Elective LV unloading with a microaxial flow pump reduced inotrope requirements but increased loss of pulse pressure and did not prevent myocardial stunning during complex PCI.
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