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Effects of hemoperfusion during percutaneous transluminal coronary angioplasty on left ventricular function
J R Azpiri1, R J Chisholm, K R Watson
1Department of Medicine, St. Michael's Hospital, University of Toronto, Ontario, Canada.
Insights
Autologous blood perfusion significantly improved left ventricular (LV) hemodynamics during percutaneous transluminal coronary angioplasty (PTCA). This hemoperfusion technique offers protection against LV dysfunction and potential cardiovascular collapse in high-risk patients.
Area of Science:
- Cardiovascular Interventions
- Hemodynamics
- Interventional Cardiology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) can induce left ventricular (LV) hemodynamic deterioration.
- Protecting LV function during PTCA is crucial, especially in high-risk patients.
Purpose of the Study:
- To evaluate the efficacy of autologous blood perfusion in mitigating LV hemodynamic compromise during PTCA.
- To assess the protective effects of hemoperfusion on LV systolic and diastolic function.
Main Methods:
- The study involved 9 patients undergoing PTCA.
- Autologous blood hemoperfusion was delivered via an angiographic power injector.
- LV pressures, dP/dt, and ST-segment shifts were recorded with and without hemoperfusion.
Main Results:
- Hemoperfusion significantly improved LV systolic pressure (p = 0.01) and reduced LV end-diastolic pressure (p < 0.001).
- Peak positive and negative dP/dt values were significantly enhanced by hemoperfusion (p < 0.05).
- Hemoperfusion demonstrated a protective effect on LV hemodynamics during balloon occlusion.
Conclusions:
- Autologous blood perfusion is a feasible method to alleviate LV hemodynamic deterioration during PTCA.
- Hemoperfusion offers substantial protection against LV dysfunction induced by PTCA.
- This technique may prevent cardiovascular collapse in high-risk PTCA procedures.
Abstract:
The effect of autologous blood perfusion, delivered through an angiographic power injector, on alleviating left ventricular (LV) hemodynamic deterioration during percutaneous transluminal coronary angioplasty (PTCA) was examined. LV systolic and diastolic pressures, LV peak positive and peak negative first derivative of LV pressure (dP/dt), and ST-segment shift were recorded in 9 patients with and without hemoperfusion. Hemoperfusion resulted in an improved LV hemodynamic profile during balloon occlusion, as reflected in LV systolic pressure (127 +/- 14 vs 120 +/- 15 mm Hg, p = 0.01), LV end-diastolic pressure (17 +/- 14 vs 25 +/- 6 mm Hg, p less than 0.001), peak positive (1,237 +/- 240 vs 1,149 +/- 225 mm Hg/s, p less than 0.05) and peak negative (1,666 +/- 357 vs 1,485 +/- 385 mm Hg/s, p = 0.003) dP/dt. Hemoperfusion provides substantial protection for significant LV dysfunction induced by conventional PTCA in 1-vessel angioplasty and is a feasible option to protect against potential cardiovascular collapse in high-risk PTCA.