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[Circulatory assistance in high-risk coronary angioplasty]
O Valsecchi1, A Casari, P Ferrazzi
1Divisione di Cardiologia, Ospedali Riuniti, Bergamo.
Insights
Cardiopulmonary support, used prophylactically or on standby, enabled high-risk patients to undergo coronary angioplasty. This technique facilitated complex procedures in patients with reduced heart function and other severe health issues.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Context:
- Coronary angioplasty (PTCA) poses significant risks for patients with compromised cardiac function or comorbidities.
- Managing high-risk patients during PTCA requires advanced support strategies.
Purpose:
- To evaluate the feasibility and utility of femoral vein to artery cardiopulmonary bypass as a prophylactic or standby measure during high-risk percutaneous coronary interventions.
Summary:
- Five high-risk patients underwent coronary angioplasty with cardiopulmonary support. Support was established via cut-down or percutaneous cannulation.
- In one case, standby support was activated due to abrupt arterial closure, necessitating an emergency graft.
- The study demonstrates that cardiopulmonary support can enable PTCA in patients with severely reduced ejection fraction and other contraindications.
Impact:
- Facilitates complex coronary angioplasty in high-risk individuals, potentially expanding treatment options.
- Highlights the role of cardiopulmonary support in mitigating procedural risks and managing complications during PTCA.
- Provides insights into the application of cardiopulmonary bypass in challenging interventional cardiology cases.
Abstract:
Femoral vein to artery cardiopulmonary by-pass was used during coronary angioplasty in five high risk patients. In four patients the target vessel supplied more than half of the viable myocardium; in one of these, the ejection fraction of the left ventricle was less than 20%. In one patient the relative contraindications for surgery were the patient's age and the presence of concomitant renal failure. Cardiopulmonary support was established by using cut-down cannulae insertion in three patients and by using the percutaneous system in two. In the latter, the support was stand-by, but the abrupt closure of the artery ten minutes after the end of the successful procedure, required the prompt activation of the support and the patient was treated with emergency saphenous graft. The use of the cardiopulmonary support either as a prophylactic or as a stand-by, enabled coronary angioplasty to be performed on these high-risk patients. The clinical and anatomical data relative to the five patients as well as the possible use of the cardiopulmonary support system either as a prophylactic or standby application during high-risk PTCA are discussed.