Authors
Ahmed Elmorsy Mohamed, Mustafa Abomohsen, Abdul Hakim Almakadma, Zeyad Kholeif, Aya Elalfy, Iyad Idries, Ahmed M Abdelkhalek, Ibrahim Elkhayat, Mohammed Ghannam, Osamah AlQassab, Azad Mojahedi, Ahmed Farid Gadelmawla, Rana Rashwan, Meena Farid, Moshe Gunsburg, Hal L Chadow
Published in
Expert review of medical devices. Sep 18, 2026. Epub Sep 18, 2026.
Abstract
Microaxial left ventricular support (MLVS; Impella, Abiomed) is increasingly used during nonemergent high-risk percutaneous coronary intervention (HR-PCI), although randomized evidence remains limited and device-related complications are a concern.
PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library were searched from inception through March 2026 for randomized and comparative observational studies of MLVS versus control during nonemergent HR-PCI. Random-effects meta-analysis, subgroup and sensitivity analyses, Bayesian modeling, risk-of-bias assessment, and GRADE were performed.
Ten studies including 7,875 patients were analyzed. MLVS was not associated with lower all-cause mortality overall (RR 1.17, 95% CI 0.81-1.67; I2 = 82.1%). Exploratory analyses showed higher mortality estimates in randomized trials (RR 1.44, 95% CI 1.05-1.97) and studies of planned pre-PCI support (RR 1.52, 95% CI 1.17-1.97). Bayesian analysis yielded a median RR of 1.14 (95% CrI 0.80-1.65; Pr[RR > 1]=77.2%). Myocardial infarction, stroke/cerebrovascular events, and MACE/MACCE were not significantly different, while major bleeding was increased (RR 1.92, 95% CI 1.14-3.23).
Current evidence does not support routine prophylactic MLVS during nonemergent HR-PCI. Selective use may remain appropriate, but further adequately powered randomized trials are needed.
PROSPERO CRD420261358349.
PMID:
42760266
Bibliographic data and abstract were imported from PubMed on 19 Sep 2026.
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