{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T07:46:30Z","timestamp":1782373590314,"version":"3.54.5"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"Supplement_7","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Johnson & Johnson MedTech HeartRecovery"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Ischaemic left ventricular dysfunction (ILVD) is the leading cause of heart failure and is commonly encountered in cardiac catheterization laboratories. Patients presenting with ILVD are typically older and often have complex coronary anatomy, making revascularization challenging. Although coronary artery bypass grafting improves long-term survival in patients with ILVD compared with medical therapy, the benefit emerges only after a decade and appears limited to younger patients, leaving many older, frail, or comorbid individuals at untenable risk. Such patients are frequently considered for complex high-risk indicated percutaneous coronary intervention (CHIP), where the primary determinant of procedural risk is intra-procedural haemodynamic instability due to limited ventricular reserve and anticipated prolonged ischaemia. Registry data underscore the heightened risk in patients with multiple CHIP features, including ejection fraction \u226430%, left main or multivessel percutaneous coronary intervention, and extensive calcification. Here, temporary mechanical circulatory support has emerged as a strategy to mitigate haemodynamic compromise during CHIP procedures. Although trial data have demonstrated no early benefit with the intra-aortic balloon pump, long-term follow-up suggests improved survival. Alternatively, microaxial flow pumps, such as Impella\u2122, can offer robust haemodynamic support and a reduction in late major adverse events. Although results from the ongoing randomized clinical trials with Impella are pending, careful Heart Team evaluation and procedural planning remain essential to ensure the best possible patient outcomes. Here, we illustrate a structured approach to Impella-supported CHIP in an elderly patient with the presence of ILVD, severely impaired ventricular reserve, and heavily calcified multivessel disease.<\/jats:p>","DOI":"10.1093\/eurheartjsupp\/suag008","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T12:22:19Z","timestamp":1771244539000},"page":"vii14-vii19","source":"Crossref","is-referenced-by-count":0,"title":["Protected complex high-risk indicated percutaneous coronary intervention in severe left ventricular dysfunction: an illustrative case highlighting patient selection, procedural planning, execution, and device management"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3008-5290","authenticated-orcid":false,"given":"Saad M","family":"Ezad","sequence":"first","affiliation":[{"name":"British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Medicine and Sciences, King\u2019s College London, Rayne Institute, St Thomas\u2019 Hospital , London SE1 7EH ,","place":["UK"]},{"name":"Dorset Heart Centre, Royal Bournemouth Hospital , Castle Lane East, Bournemouth BH7 7DW ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Alkhalil","sequence":"additional","affiliation":[{"name":"Cardiothoracic Centre, Freeman Hospital , Newcastle upon Tyne NE7 7DN ,","place":["UK"]},{"name":"Translational and Clinical Research Institute, Newcastle University , Newcastle upon Tyne NE1 7RU ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Monteagudo-Vela","sequence":"additional","affiliation":[{"name":"Harefield Hospital, Royal Brompton and Harefield Hospitals, part of Guy\u2019s and St Thomas\u2019 NHS Foundation Trust , Hill End Road, UB9 6JH, Harefield, London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2338-8346","authenticated-orcid":false,"given":"Christophe","family":"Vandenbriele","sequence":"additional","affiliation":[{"name":"Heart Center AZORG , Campus Moorselbaan, Moorselbaan 164, 9300 Aalst ,","place":["Belgium"]},{"name":"Cardiac Intensive Care, Royal Brompton and Harefield Hospitals, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust , London SW3 6NP ,","place":["UK"]},{"name":"Department of Surgery and Cancer, Faculty of Medicine, Imperial College London , Exhibition Road, London SW7 2AZ ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios","family":"Panoulas","sequence":"additional","affiliation":[{"name":"Harefield Hospital, Royal Brompton and Harefield Hospitals, part of Guy\u2019s and St Thomas\u2019 NHS Foundation Trust , Hill End Road, UB9 6JH, Harefield, London ,","place":["UK"]},{"name":"Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London , Royal Brompton Campus, Guy Scadding Building, Cale Street, London SW3 6LY ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0793-7923","authenticated-orcid":false,"given":"Norman","family":"Mangner","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cardiology, Heart Centre Dresden, University Hospital, Technische Universit\u00e4t Dresden , Fetscherstra\u00dfe 76, 01307 Dresden ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"key":"2026062502515079900_suag008-B1","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1161\/CIRCULATIONAHA.116.024800","article-title":"Ten-year outcomes after coronary artery bypass grafting according to age in patients with heart failure and left ventricular systolic dysfunction: an analysis 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