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[Percutaneous coronary transluminal angioplasty with extracorporeal circulation: preliminary results]
Insights
Cardiopulmonary bypass support (CPS) can be safely used in high-risk percutaneous transluminal coronary angioplasty (PTCA) patients, especially those with low ejection fraction or contraindications to surgery. This approach may expand PTCA indications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) poses risks for patients with low ejection fraction (EF) or extensive viable myocardium.
- Acute closure during PTCA can lead to hemodynamic collapse in high-risk individuals.
Purpose of the Study:
- To evaluate the safety and efficacy of cardiopulmonary bypass support (CPS) in patients undergoing high-risk PTCA.
- To determine if CPS can expand PTCA indications in patients unsuitable for surgery.
Main Methods:
- Retrospective analysis of 11 patients (9 male, 2 female; mean age 70) who received CPS during PTCA.
- Patients were categorized into two groups: contraindication to surgery (Group I) or unstable angina with low EF/large myocardial territory (Group II).
- Thirty coronary lesions were treated, with 28 successfully dilated; two also underwent aortic dilation.
Main Results:
- Nine out of eleven patients (82%) showed improvement, with Canadian Angor Class I at follow-up (mean 3.9 months).
- One peri-procedural death occurred due to hypovolemic collapse; another late death was due to pulmonary neoplasia.
- The procedure was technically successful in most cases, with manageable complications.
Conclusions:
- Cardiopulmonary bypass support is a safe option for high-risk PTCA patients, including those with contraindications to surgery.
- Utilizing CPS may broaden the applicability of PTCA in complex cardiovascular cases.
- Careful patient selection and procedural management are crucial for optimal outcomes.
Abstract:
Percutaneous transluminal coronary angioplasty (PTCA) in patients with low ejection fraction (EF) and/or a large area of remaining viable myocardium served by the target vessel can cause hemodynamic collapse in case of acute closure. We report 11 patients in whom the cardiopulmonary bypass support (CPS) was instituted because of contraindication to surgery (Group I) or unstable angina associated with low EF and/or a large amount of myocardium perfused by the target artery (Group II). Nine were male and 2 female, mean ages of 70, with Canadian angor class I (1), II (1), or IV (9) and EF ranging from 12 to 65% (mean 34%). Thirty were the lesions to dilate; 28 were dilated successfully; in 2 an aortic dilation was also performed. One death occurred after the procedure related to collapse due to hypovolemia; another death occurred 8 months after PTCA because of pulmonary neoplasia. The other 9 patients followed-up at 1 to 8 months (mean 3.9) disclosed Canadian angor class I. The procedure's technique and the related complications are discussed. We conclude that cardiopulmonary bypass support can be used safely in patients refused to surgery and with high risk PTCA; such a procedure may expand the indication of PTCA.