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Clinical application of percutaneous cardiopulmonary bypass for high risk coronary angioplasty
M R Mooney1, J F Mooney, D W Mathias
1Minneapolis Heart Institute, Abbott Northwestern Hospital, MN 55407.
Insights
Percutaneous cardiopulmonary bypass safely supports high-risk patients undergoing coronary angioplasty. This method enables effective intervention even with temporary loss of heart systolic function during the procedure.
Area of Science:
- Cardiology
- Cardiovascular Surgery
Background:
- Percutaneous coronary angioplasty (PCI) poses risks for patients with extensive myocardial territory or left ventricular (LV) dysfunction.
- Hemodynamic collapse during PCI necessitates advanced support strategies.
Observation:
- Elective percutaneous cardiopulmonary bypass (PCPS) was used in 16 high-risk patients before PCI.
- Patients had significant LV dysfunction (ejection fraction <40%) supplying >2/3 of the myocardium.
- Temporary loss of systolic function occurred in 56% of patients during balloon inflation.
Findings:
- PCPS was technically successful in all 16 patients (100%) and clinically successful in 14 (88%).
- The procedure allowed PCI in patients experiencing complete systolic dysfunction.
- Mean 10-month follow-up showed 10 patients asymptomatic and 3 with mild angina.
Implications:
- PCPS is a viable and effective option for carefully selected high-risk patients undergoing PCI.
- This approach enhances safety and efficacy, particularly when systolic function is compromised.
- It expands treatment options for complex coronary artery disease.
Abstract:
Percutaneous cardiopulmonary bypass support was electively instituted prior to coronary angioplasty in 16 patients at high risk for hemodynamic collapse. In all cases the dilated artery supplied greater than 2/3 of the functioning myocardium. Eight patients had moderate LV dysfunction with ejection fraction 25-40%. Eight patients had an ejection fraction less than 20%. A 21 French cannula and a 17 French cannula were percutaneously inserted into the femoral vein and artery. Cardiopulmonary bypass support was instituted using a Bio-Medicus centrifugal pump just prior to coronary angioplasty at flow rates of 3.5-5 liters/minute. Thirteen patients had single vessel angioplasty and three patients had multivessel angioplasty. Complete loss of systolic function was observed in 9 (56%) patients. This finding when present confirms the absolute requirement for cardiopulmonary support. Technical success was achieved in all 16 patients (100%), clinical success was achieved in 14 patients (88%). Patient followup (mean 10 months) revealed 3 patients with class I-II angina and 10 patients were asymptomatic. There was one late death. In conclusion, percutaneous cardiopulmonary bypass support for carefully selected high risk patients may allow coronary angioplasty to be performed safely and effectively despite complete loss of systolic function during balloon inflation.