PIvotal Trial of the KARDION Cory P4 MechANical Circulatory SupporT SystEm

Eligibility Criteria

• 1. Subject age ≥ 18 and ≤ 90 years at the time of screening
• 2. The subject has an LV ejection fraction of \< 50% (within 90 days of index procedure) AND is at high-risk due to any of the following:
• * Unprotected left main coronary artery stenosis disease
• * Last remaining epicardial native coronary artery
• * Significant three vessel coronary artery disease
• * Significant two vessel coronary artery disease of complex lesions
• * Significant single vessel coronary artery disease of complex lesions and non-treated CTO
• * Target vessel is a CTO with planned retrograde approach
• * Intended calcium modification (by atherectomy, lithotripsy or laser)
• * In multiple vessels OR
• * In the left main OR
• * In a final patent conduit OR
• * Where the anatomic SYNTAX score is ≥32
• 3. Local heart team (interventional cardiologist, cardiac surgeon) has determined that the subject is an appropriate candidate for a PCI supported with a Mechanical Circulatory Support (MCS) System
• 4. Confirmed access site vasculature greater than 5.5 mm as measured by CT or femoral duplex ultrasound
• 5. The subject is willing and able to comply with the protocol-specified treatment and follow-up evaluations
• 6. The subject has been informed of the nature of the trial, agrees to its provisions, and has provided written informed consent approved by the appropriate Institutional Review Board (IRB) or Ethics Committee (EC)
• 1. Any prior coronary revascularization or revascularization attempt within 30 days prior to index procedure
• 2. STEMI within 7 days prior to index procedure - defined as new ST elevation at the J point in at least 2 contiguous leads of ≥ 2 mm (0.2 mV) in men or ≥ 1.5 mm (0.15 mV) in women in leads V2-V3 and/or of ≥ 1 mm (0.1 mV) in other contiguous chest leads or the limb leads
• 3. Non-STEMI within 7 days prior to index procedure with an elevated cardiac biomarker (CK-MB or Troponin \>1x ULN) without CK-MB or Troponin value down trending
• 4. Cardiac arrest within 7 days prior to index procedure requiring CPR or defibrillation
• 5. Subjects with sustained ventricular tachycardia or repetitive/ prolonged non-sustained ventricular tachycardia or complex ventricular ectopy
• 6. Current left ventricular thrombus
• 7. Significant right heart failure (right ventricular fractional area change \<35% on echocardiography)
• 8. Known severe pulmonary hypertension (right ventricular systolic pressure (RVSP) on echo or pulmonary artery systolic pressure (PASP) on right heart catheterization \> 70mmHg
• 9. Combined cardiorespiratory failure
• 10. Presence of an atrial or ventricular septal defect (including post-infarct VSD)
• 11. Hypertrophic obstructive cardiomyopathy (HOCM), restrictive cardiomyopathy, or constrictive pericarditis
• 12. Cardiogenic shock (Cardiac index \< 1.8 l/min/m2) or pre-procedure use of inotropic or pressor therapy within 72 hours of the planned index procedure
• 13. Any use of mechanical circulatory support or an extracorporeal membrane oxygenation device within 14 days prior to index procedure
• 14. Severe aortic valve insufficiency or stenosis or aortic valve replacement
• 15. Aortic vascular disease (i.e., aortic aneurysm, dissection, extreme tortuosity or calcification that creates additional risk to the placement of a MCS device)
• 16. Cerebrovascular Accident (CVA) within 180 days prior to index procedure
• 17. Transient Ischemic Attack (TIA) within 90 days prior to index procedure
• 18. Known or suspected coagulopathy or abnormal coagulation parameters (defined as platelet count ≤ 100,000 or spontaneous INR ≥ 1.5 or known fibrinogen ≤ 1.5 g/l)
• 19. Known hemoglobin diseases, such as sickle cell anemia, hemolytic anemia or thalassemia
• 20. Subject has evidence of an active infection on the day of the index procedure requiring oral or intravenous antibiotics
• 21. Active infection of the intended access site
• 22. Chronic renal dysfunction (eGFR \< 30 mL/min/1.73 m²) and/or patients requiring renal replacement therapy with dialysis
• 23. History of liver dysfunction with elevation of liver enzymes and bilirubin 3 times the upper limit of normal (ULN) within 90 days prior to index procedure
• 24. Known or suspected severe pulmonary disease (e.g., forced expiratory volume (FEV)1 \< 1.0 l/s)
• 25. Allergy, sensitivity or intolerance to anesthesia, heparin, aspirin, adenosine diphosphate (ADP) receptor blockers, or contrast media, including known heparin-induced thrombocytopenia (HIT)
• 26. Any non-cardiac condition with life expectancy \< 3 years (e.g., cirrhosis, oxygen or oral steroid dependent COPD, cancer, etc.)
• 27. Subject is presently or recently intubated for the current admission (NOTE: recently intubated patients must be extubated for \> 24 hours with full neurologic recovery)
• 28. Decompensated heart failure requiring IV diuretics, vasopressors, or inotropic support within 2 days of index procedure
• 29. Morbid obesity (BMI ≥ 40 kg/m²)
• 30. Patients with an organ transplant
• 31. Patients with implanted left ventricular assist device
• 32. Cardiac tamponade
• 33. Left ventricular rupture
• 34. Women who are lactating, pregnant, or plan to become pregnant during the course of the investigation
• 35. Active COVID-19 infection
• 36. Any anatomical restriction that would preclude an MCS device from being delivered through the femoral artery to the left ventricle
• 37. Subject has other medical, social or psychological problems that, in the opinion of the Investigator, compromises the subject's ability to give written informed consent and/or to comply with trial procedures
• 38. Current participation in another investigational drug or device trial
• 39. Anticipated need for continued MCS support after conclusion of the PCI procedure