The Maryland experience: angioplasty and valvuloplasty using percutaneous cardiopulmonary support

Vessel closure during coronary angioplasty in patients with poor ventricular function or extensive distribution of the target vessel, or both, can result in hemodynamic collapse--a potentially fatal complication. A similar situation can develop as a result of problems arising during aortic valvuloplasty. In an attempt to extend the benefits of angioplasty and valvuloplasty to patients with more advanced coronary and valvular heart disease, semipercutaneous cardiopulmonary circulatory support has been used as an adjunct to these interventions. In our initial experience with supported angioplasty/valvuloplasty, 11 vessels in 9 patients and 6 aortic valves were successfully dilated. Complete cardiopulmonary support was achieved in all cases, permitting prolonged balloon inflations; intraprocedural complications were limited to vessel injury and blood loss. One patient each died after angioplasty and valvuloplasty. Symptomatic improvement was observed in all surviving patients.