Initial report of the National Registry of Elective Cardiopulmonary bypass supported coronary angioplasty

Abstract

Relative contraindications to coronary angioplasty have been large amounts of jeopardized myocardium and poor left ventricular function. To prevent possible hemodynamic collapse after balloon occlusion or acute vessel closure in such high risk patients, a cardiopulmonary bypass system capable of providing up to 6 liters/min output was employed prophylactically. This technique, termed supported angioplasty, results in reductions of preload and afterload and allows prolonged balloon inflations in critical coronary vessels. A National Registry of 14 centers performing elective supported angioplasty was formed to collate the initial experience with high risk patients. Suggested indications were ejection fraction less than 25% or a target vessel supplying more than half the myocardium, or both. During 1988, the data from 105 patients (mean age 62 years) undergoing supported angioplasty were entered into the Registry. This group included 20 patients whose disease was deemed too severe to permit bypass surgery and 30 patients who had dilation of their only patent coronary vessel. Seventeen patients had stenosis of the left main coronary artery and 15 underwent dilation of that vessel. Chest pain and electrocardiographic changes occurred uncommonly despite prolonged balloon inflations. During the trial, there was a progressive change from cutdown insertion to percutaneous insertion of the circulatory support cannulas. The angioplasty success rate was 95% for the 105 patients, who underwent an average of 1.7 dilations per patient. Morbidity was frequent (41 patients), in most cases due to arterial, venous or nerve injury associated with cannula insertion or removal, or both.(ABSTRACT TRUNCATED AT 250 WORDS)

National Registry for Supported Angioplasty: Results and Follow-Up of Three Years of Supported and Standby Supported Angioplasty in High-Risk Patients

“…Shortly thereafter, because of the enthusiasm for the procedure, a registry was formed to collect data on patients undergoing supported angioplasty [6,7],…”

Factors for Weaning From a Percutaneous Cardiopulmonary Support System (PCPS) in Patients With Severe Cardiac Failure A Comparative Study in Weaned and Nonweaned Patients

“…(Int Heart J 2006; 47: 575-584) Key words: Heart failure, Percutaneous cardiopulmonary support system (PCPS), Circulatory support THE percutaneous cardiopulmonary support system (PCPS), which can supply hemodynamic volume assistance, was first described by Phillips and coworkers in 1983. 1) Subsequently, favorable results 2) and remarkable advances in catheters and membrane oxygenators have resulted in the wide acceptance of this approach for circulatory support. Therefore, PCPS has been wildly used for severe cardiac failure, cardiogenic shock, and/or postoperative cardiac support.…”

Devices in Heart Failure

“…In addition, patients undergoing high-risk interventions can benefit from MCS; these include those with low EF or the target vessel supplying more than half of the myocardium. 34 IABP are an example of these devices (described in "Aortic Counterpulsation"); others are described below. The TandemHeart (CardiacAssist, Inc, Pittsburgh, PA, USA) is a centrifugal pump that can be used with or without a membrane oxygenator; it requires a 21Fr transseptal cannula that takes blood from the left atrium and deposits it into the iliac artery.…”