Coronary Artery Disease | Dr. Ge Junbo (Cardiology) | CMCS Shanghai

About Dr. Ge Junbo

Dr. Ge Junbo is a world-renowned interventional cardiologist at Zhongshan Hospital, Fudan University — one of China's foremost centres for interventional cardiology, structural heart disease, and complex percutaneous coronary intervention (PCI), and a national reference institution for the management of coronary artery disease and heart failure. He is recognised as a pioneer of interventional cardiology in China, having led landmark clinical trials that have shaped the evidence base for PCI practice in the Chinese population, and as a global authority on complex high-risk and indicated PCI (CHIP) — the management of patients with severely reduced left ventricular function, complex coronary anatomy, and high procedural risk who were previously considered unsuitable for revascularisation. Dr. Ge's clinical philosophy holds that the boundary of what is achievable in interventional cardiology is defined not by the complexity of the disease but by the quality of the team, the precision of the procedural planning, and the availability of haemodynamic support technology that can sustain the patient through the physiological demands of complex revascularisation. His department at Zhongshan Hospital has established one of Shanghai's most advanced interventional cardiology programmes, integrating intracoronary imaging, physiological assessment, rotational atherectomy, and percutaneous mechanical circulatory support into a unified CHIP care pathway that has enabled curative revascularisation for patients who would previously have been offered only medical therapy.

Case Overview

A 74-year-old Chinese man presented with recurrent chest tightness and was diagnosed with complex high-risk coronary artery disease at Zhongshan Hospital, Fudan University. His left ventricular ejection fraction (LVEF) was severely reduced at 30%, and coronary imaging demonstrated severe stenosis with heavily calcified and tortuous lesions — the combination that defines the complex high-risk and indicated PCI (CHIP) patient phenotype. The risk of haemodynamic compromise during PCI was assessed as extremely high. Dr. Ge Junbo's team formulated a strategy that incorporated prophylactic haemodynamic support: prior to PCI, the SynFlow3.0 percutaneous trans-valvular ventricular assist device — a domestically developed mechanical circulatory support system — was deployed via the left femoral artery to provide ventricular unloading and haemodynamic stabilisation throughout the procedure. Under this support, Dr. Ge performed PCI with successful revascularisation of the target lesions. Intraoperative haemodynamic fluctuations were managed with the SynFlow3.0 in situ. The procedure lasted two hours and was completed without major complications. The patient recovered well and was discharged in good condition. This case represents a landmark achievement — the first application of the domestically developed SynFlow3.0 ventricular assist device to support complex high-risk PCI at this level of complexity, demonstrating that Chinese-developed mechanical circulatory support technology can match international standards and extend the reach of curative revascularisation to the highest-risk patients.

Patient Background

• Name / Nationality: Mr. Chen (pseudonym) — Chinese male, 74 years old
• Age / Sex: 74-year-old male
• Chief Complaint: Recurrent chest tightness; exertional dyspnoea; reduced exercise tolerance
• History of present illness: Progressive recurrent chest tightness and exertional dyspnoea over the preceding period; symptoms consistent with angina and heart failure secondary to severe coronary artery disease with impaired left ventricular function. The patient had been evaluated at other institutions; the complexity of his coronary anatomy and the severity of his left ventricular dysfunction had led to the assessment that PCI carried prohibitive risk and that he was not a candidate for surgical revascularisation. He was referred to Zhongshan Hospital for specialist CHIP assessment and management.
• Cardiovascular risk profile: Age 74; severely reduced LVEF 30% — consistent with ischaemic cardiomyopathy; heavily calcified and tortuous coronary lesions; haemodynamic instability risk assessed as extremely high during PCI; CHIP phenotype confirmed by MDT assessment
• Functional status: Significantly limited by symptoms; exercise tolerance markedly reduced; quality of life substantially impaired

Diagnostic Workup

Cardiac Imaging and Functional Assessment

• Echocardiography: LVEF 30% — severely reduced; regional wall motion abnormalities consistent with ischaemic cardiomyopathy; left ventricular dimensions and diastolic function assessed; valvular function evaluated
• Coronary angiography: Severe stenosis of the target coronary vessels; heavily calcified lesions — calcium arc and length assessed; tortuous vessel anatomy — increasing the technical difficulty of wire passage, balloon delivery, and stent deployment; assessment of collateral circulation and myocardial viability in the territory of the target lesions
• Intracoronary imaging (IVUS/OCT): Detailed characterisation of lesion calcium burden, distribution, and depth — essential for planning atherectomy strategy and stent sizing; assessment of the landing zones for stent deployment
• Physiological assessment: Fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) assessment of haemodynamic significance of target lesions where applicable
• Haemodynamic risk assessment: LVEF 30%, complex multivessel disease, and calcified tortuous anatomy — CHIP criteria confirmed; risk of haemodynamic collapse during balloon inflation and ischaemia in the territory of the target vessel assessed as extremely high

Dr. Ge's pre-procedural assessment: This patient represents the CHIP phenotype in its most challenging form — severely impaired left ventricular function, heavily calcified and tortuous coronary anatomy, and an age and comorbidity profile that makes surgical revascularisation high-risk. The combination of LVEF 30% and the calcified tortuous lesions means that every balloon inflation during PCI will produce a period of ischaemia in a ventricle that has almost no reserve — the risk of haemodynamic collapse during the procedure is real and significant. The SynFlow3.0 ventricular assist device changes the risk calculus: by providing continuous mechanical circulatory support throughout the procedure, it maintains cardiac output and coronary perfusion pressure during the periods of ischaemia produced by balloon inflation, giving us the haemodynamic stability we need to work carefully and precisely on these complex lesions. The calcification will require atherectomy to modify the plaque before we can deliver and expand the stent — and atherectomy in a vessel supplying a ventricle with LVEF 30% is a procedure that requires haemodynamic support. With the SynFlow3.0 in place, we can perform the atherectomy and the stenting with the confidence that the patient's haemodynamics will be supported if they deteriorate. This is what CHIP PCI looks like when it is done correctly: meticulous planning, the right support technology, and a team that has rehearsed every contingency.

Treatment Strategy: CHIP PCI with Prophylactic Mechanical Circulatory Support

Pre-procedural planning: MDT discussion involving interventional cardiology, cardiac surgery, cardiac anaesthesia, and critical care; CHIP criteria confirmed; decision to proceed with PCI with prophylactic SynFlow3.0 ventricular assist device support; atherectomy strategy planned based on intracoronary imaging calcium assessment; stent sizing and landing zone planning completed

Procedural strategy — SynFlow3.0-Supported Complex High-Risk PCI:

• Vascular access: Left femoral artery access established for SynFlow3.0 deployment; radial or femoral arterial access for PCI guide catheter
• SynFlow3.0 deployment: The SynFlow3.0 percutaneous trans-valvular ventricular assist device — a domestically developed axial flow pump — advanced via the left femoral artery across the aortic valve into the left ventricle; device activated to provide continuous left ventricular unloading and haemodynamic support; haemodynamic parameters confirmed to be within target range before proceeding with PCI
• Lesion preparation: Rotational atherectomy performed to modify the heavily calcified lesions — debulking the calcium to allow balloon expansion and stent delivery; atherectomy performed under continuous SynFlow3.0 support
• PCI and stenting: Balloon pre-dilatation of the prepared lesions; drug-eluting stent deployment with intracoronary imaging guidance to confirm optimal stent expansion and apposition; post-dilatation with non-compliant balloon to achieve full stent expansion within the calcified segments
• Haemodynamic management: Intraoperative haemodynamic fluctuations managed with SynFlow3.0 support in situ; vasopressor support titrated as required; continuous monitoring of arterial pressure, cardiac output, and device parameters throughout
• Procedural completion: Angiographic confirmation of successful revascularisation — TIMI 3 flow restored in the target vessels; SynFlow3.0 weaned and removed following haemodynamic stabilisation; vascular access sites closed; patient transferred to cardiac intensive care unit for monitoring

Total procedure duration: Two hours

Treatment Course and Outcomes

Intraoperative

• SynFlow3.0 ventricular assist device deployed successfully via the left femoral artery; haemodynamic support confirmed prior to PCI; rotational atherectomy performed on calcified lesions; drug-eluting stents deployed with intracoronary imaging guidance; intraoperative haemodynamic fluctuations managed with SynFlow3.0 support; TIMI 3 flow achieved in target vessels; procedure completed in two hours without major complications

Postoperative Recovery

• Patient transferred to cardiac intensive care unit for postoperative monitoring; haemodynamically stable; no major procedural complications
• Progressive clinical improvement; cardiac function monitoring with serial echocardiography; antiplatelet and heart failure medical therapy optimised
• Patient discharged in good condition; outpatient cardiology follow-up arranged
• Quality of life: significant improvement in symptoms; chest tightness resolved; exercise tolerance improving

Dr. Ge's clinical reflection: The SynFlow3.0 is not simply a safety net — it is what makes this procedure possible. Without haemodynamic support, the combination of LVEF 30% and the ischaemia produced by atherectomy and balloon inflation in a major coronary vessel would carry a prohibitive risk of haemodynamic collapse. With the SynFlow3.0 providing continuous ventricular unloading and maintaining cardiac output throughout the procedure, we were able to perform the atherectomy and the stenting with the precision and patience that complex calcified lesions require — without the pressure of a deteriorating haemodynamic situation forcing us to cut corners or abort the procedure. The fact that this device is domestically developed is significant: it means that Chinese patients with CHIP can access this level of haemodynamic support without dependence on imported technology, and it means that the cost and availability barriers that have previously limited access to mechanical circulatory support-assisted PCI in China can be progressively reduced. This patient came to us having been told that his coronary disease was too complex and his heart too weak for intervention. He left the hospital with his coronary arteries revascularised and his symptoms resolved. That is what CHIP PCI with the right support technology can achieve.

Expert Commentary — Dr. Ge Junbo

1. The CHIP Patient: Defining Complexity, Risk, and the Case for Revascularisation

The complex high-risk and indicated PCI (CHIP) patient represents the frontier of interventional cardiology — patients whose coronary disease is severe enough to cause significant symptoms and impair survival, but whose clinical profile — severely reduced left ventricular function, complex multivessel disease, advanced age, and multiple comorbidities — makes the procedural risk of revascularisation high enough that they have historically been denied intervention and managed with medical therapy alone. The CHIP phenotype is defined by the combination of clinical high risk — LVEF below 35%, haemodynamic instability, or dependence on inotropic support — and anatomical complexity — left main disease, multivessel disease, heavily calcified or tortuous lesions, or chronic total occlusions. In this patient, the LVEF of 30% and the heavily calcified tortuous coronary anatomy represent both dimensions of the CHIP phenotype simultaneously. The case for revascularisation in CHIP patients rests on the evidence that successful revascularisation — when it can be achieved safely — produces meaningful improvements in symptoms, exercise tolerance, and quality of life, and may improve survival in patients with viable but ischaemic myocardium. The challenge is achieving that revascularisation safely in patients whose haemodynamic reserve is so limited that the ischaemia produced by balloon inflation during PCI may precipitate haemodynamic collapse. Mechanical circulatory support — by maintaining cardiac output and coronary perfusion pressure during the periods of ischaemia produced by the procedure — is the technology that makes safe CHIP PCI possible.

2. Percutaneous Mechanical Circulatory Support in CHIP PCI: Device Selection, Deployment, and Haemodynamic Management

Percutaneous mechanical circulatory support (pMCS) devices for CHIP PCI work by augmenting cardiac output during the procedure, reducing left ventricular wall stress and myocardial oxygen demand, and maintaining coronary perfusion pressure during the periods of ischaemia produced by balloon inflation and atherectomy. The available pMCS devices differ in their mechanism of action, the degree of haemodynamic support they provide, and their vascular access requirements. The intra-aortic balloon pump (IABP) — the most widely used pMCS device — provides modest haemodynamic support through diastolic augmentation and systolic unloading, but its support is insufficient for the most haemodynamically unstable CHIP patients. Axial flow pump devices — including the Impella family and the domestically developed SynFlow3.0 — provide active left ventricular unloading by drawing blood from the left ventricle and expelling it into the ascending aorta, producing a degree of haemodynamic support that is proportional to the pump flow rate and substantially greater than that achievable with IABP. The SynFlow3.0, deployed in this case, is a Chinese-developed percutaneous trans-valvular axial flow pump that provides continuous left ventricular unloading via femoral arterial access — offering a domestically available alternative to imported axial flow pump devices that has been developed to meet the specific anatomical and clinical characteristics of the Chinese patient population. The deployment of the SynFlow3.0 prior to the initiation of PCI — prophylactic rather than rescue support — reflects the evidence that prophylactic pMCS in CHIP PCI produces better haemodynamic stability and procedural outcomes than rescue deployment after haemodynamic compromise has already occurred.

3. Calcified Coronary Lesions in CHIP PCI: Atherectomy Strategy, Stent Optimisation, and the Role of Intracoronary Imaging

Heavily calcified coronary lesions represent one of the most technically demanding challenges in interventional cardiology — and their prevalence is highest in precisely the CHIP patient population, where the combination of advanced age, diabetes, chronic kidney disease, and long-standing coronary artery disease produces the most severe and extensive coronary calcification. Calcified lesions resist balloon expansion, prevent adequate stent deployment, and are associated with stent underexpansion, malapposition, and the consequent risks of stent thrombosis and restenosis. The management of calcified lesions in CHIP PCI requires a systematic approach: intracoronary imaging — intravascular ultrasound (IVUS) or optical coherence tomography (OCT) — to characterise the calcium arc, length, and depth and determine the atherectomy strategy; rotational or orbital atherectomy to modify the calcium and allow balloon expansion; balloon pre-dilatation with scoring or cutting balloons to further prepare the lesion; drug-eluting stent deployment with intracoronary imaging guidance to confirm optimal expansion and apposition; and high-pressure post-dilatation with non-compliant balloons to achieve full stent expansion within the calcified segments. In CHIP patients, each of these steps carries haemodynamic risk — atherectomy in particular produces periods of ischaemia that can precipitate haemodynamic deterioration in a ventricle with severely reduced reserve. The availability of the SynFlow3.0 ventricular assist device in this case provided the haemodynamic safety margin that allowed the atherectomy and stenting to be performed with the precision and thoroughness that calcified lesions require — without the pressure of haemodynamic deterioration forcing procedural compromise.

How CMCS Shanghai Coordinated This Case

CMCS Shanghai supported Mr. Chen and his family throughout the diagnostic, procedural, and recovery pathway at Zhongshan Hospital, Fudan University, including: priority consultation coordination with Dr. Ge Junbo's interventional cardiology team, with bilingual review of all prior cardiac imaging, echocardiography, coronary angiography, and clinical records; bilingual interpretation throughout the MDT discussion, procedural planning consultation, and all postoperative review appointments; bilingual explanation of the CHIP PCI procedure, the SynFlow3.0 ventricular assist device, the haemodynamic support strategy, the expected procedural timeline, and the postoperative monitoring and recovery plan; coordination of pre-procedural echocardiography, intracoronary imaging, and physiological assessment with bilingual results communication and clinical summary; bilingual procedural consent process — ensuring the patient and family had a complete understanding of the procedural risks, the haemodynamic support strategy, and the expected benefits of successful revascularisation; postoperative cardiac intensive care coordination with bilingual family communication throughout the monitoring period; and outpatient cardiology follow-up coordination including echocardiographic reassessment of left ventricular function and antiplatelet therapy management.

For international patients with coronary artery disease — including complex high-risk cases with severely reduced left ventricular function, calcified coronary anatomy, or prior assessment as unsuitable for revascularisation — seeking specialist interventional cardiology evaluation and treatment in Shanghai, Dr. Ge Junbo's team at Zhongshan Hospital, Fudan University, offers a world-class CHIP PCI programme combining advanced haemodynamic support technology, intracoronary imaging-guided atherectomy and stenting, and multidisciplinary perioperative care. CMCS ensures that expertise is accessible: in the patient's language, with every step of the complex procedural and recovery pathway coordinated and communicated clearly, from the first specialist consultation through long-term cardiac follow-up.

This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.