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Percutaneous cardiopulmonary bypass support in high-risk patients undergoing percutaneous transluminal coronary
F A Shawl1, M J Domanski, S Punja
1Department of Interventional Cardiology, Washington Adventist Hospital, Takoma Park, Maryland 20912.
Insights
Percutaneous cardiopulmonary bypass support safely enhances high-risk coronary angioplasty for patients with severe heart conditions. This technique proved effective, leading to successful procedures and improved patient outcomes post-angioplasty.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Background:
- High-risk patients with severe coronary artery disease (CAD) and impaired left ventricular function pose significant challenges for elective percutaneous coronary intervention (PCI).
- Traditional surgical revascularization may be prohibitive for a substantial subset of these patients due to comorbidities and low ejection fraction.
- The need for advanced hemodynamic support during complex PCI procedures is critical to mitigate risks.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous cardiopulmonary bypass (PCB) support in patients undergoing high-risk elective coronary angioplasty.
- To assess the feasibility of PCB in patients with severely compromised cardiac function and extensive CAD.
- To determine procedural success rates and clinical outcomes in this challenging patient population.
Main Methods:
- Fifty-one consecutive patients with low ejection fraction and significant CAD underwent elective PCI with PCB support.
- Patients had Canadian Cardiovascular Society class III/IV angina, history of myocardial infarction, and impaired left ventricular function.
- PCB was instituted percutaneously, providing circulatory support during angioplasty of complex lesions, including left main and multi-vessel disease.
Main Results:
- Percutaneous cardiopulmonary bypass support was successfully instituted in all patients, with angioplasty achieving a 98.3% lesion success rate (115/117).
- The procedure was well-tolerated, with no hospital deaths directly related to the bypass support.
- At 4.9-month follow-up, 66% of patients were asymptomatic, and 95% were in Canadian Cardiovascular Society class I or II.
Conclusions:
- Percutaneous cardiopulmonary bypass support is a safe and effective strategy for selected patients undergoing high-risk elective coronary angioplasty.
- This technology enables successful revascularization in patients with severely impaired left ventricular function and prohibitive surgical risk.
- PCB support significantly improves clinical outcomes and symptom relief in this high-risk cohort.
Abstract:
Fifty-one consecutive patients in whom percutaneous cardiopulmonary bypass support was instituted to enhance the safety of high-risk elective coronary angioplasty were studied. All patients had a low ejection fraction, a large amount of viable myocardium perfused by the target artery(s) or both. Thirty-five men and 16 women, mean age 63 years, with Canadian Cardiovascular Society class III angina (23 patients) or class IV (28 patients) were studied. There was a history of myocardial infarction in 45 (88%), bypass surgery in 14 (27%) and congestive heart failure in 17 (33%). Forty-six (90%) had impaired left ventricular function. Twenty (39%) had an ejection fraction of less than or equal to 25%. Left main stenosis was present in 9 (18%), 3-vessel disease in 48 (94%) and 2-vessel disease in 2 (4%). Twenty (39%) were considered at a prohibitive risk for bypass surgery (14 were turned down for surgery). Bypass was instituted percutaneously with flows ranging from 2 to 5 liters/min (mean 3.6). Angioplasty was successful in 115 of the 117 lesions attempted with the culprit vessel dilated in all. Dilatation of the only remaining vessel was performed in 14 (27%). Inflation times up to 10 minutes were well tolerated. Bypass was discontinued after a mean bypass time of 37 minutes. Hemostasis was achieved by external clamp compression in 50. There were 3 hospital deaths unrelated to bypass. Patient follow-up at 2 to 8 months (mean 4.9) disclosed 1 late death, 31 (66%) asymptomatic patients, 12 (26%) patients in class I and 4 patients (9%) in class II. Thus, this study demonstrates the safety and efficacy of percutaneous bypass support in selected patients undergoing high-risk coronary angioplasty.