16: A Guardian in the Cathlab. Dr. Lorenz Azzalini on mechanical circulatory support devices

We all know that heart disease is the number 1 killer worldwide. And patients die either because of acute coronary syndromes (myocardial infarction) or because of left ventricular dysfunction (heart failure). And, as an interventionist, being trapped with both evils; severe coronary stenosis and left ventricular dysfunction is scary. The only solution then is usually revascularization but it also comes with risks of myocardial injury and impaired organ perfusion. There is already an entire system with bypass surgery that perfuses the organs while the heart is paralyzed, the bypass machine. Unfortunately, surgery is not always available, many patients refuse surgery, and others may be declined by the surgeons because of their high risk. Here, cath interventions are the only hope. In addition to the gadgets available to handle the coronary occlusions, there is a need for devices to support the circulation and blood pressure during cardiogenic shock or when the heart is stunned during complex coronary intervention. The last thing we want is to have a patient crashing on-table or shortly after.And to review these devices that support the heart and the circulation in complex PCI (I call them the guardian in the cath lab), I am glad to host today one of the International experts on complex coronary interventions and mechanical circulatory support. Dr. Lorenzo Azzalini. Dr. Azzalini is the Director of the Complex Coronary Interventions Program and associate professor of medicine at Virginia Commonwealth University, in Richmond, VA. Before joining VCU he was co-director of the chronic total occlusion program at San Raffaele Hospital in Milan, Italy. And San Rafaelle was one of the centers of excellence in Europe. Dr. Azzalini’s clinical and research expertise is represented by chronic total occlusion PCI, atherectomy, mechanical circulatory support, and acute kidney injury after PCI. He has over 170 international publications, more than 3700 citations, has received numerous international awards, is a member of the editorial board of the Canadian Journal of Cardiology, Eurointervention, Cardiovascular Revascularization Medicine, and Minerva Cardiology and Angiology, and is a guest reviewer for other twenty journals. And he is a wiz inside the cath lab. I had the chance to work with him several times in the cath lab and I would describe his skills as amazing.