Percutaneous Cardiopulmonary Support-Supported Percutaneous Coronary Intervention: A Single Center Experience

Abstract

Background and ObjectivesPercutaneous cardiopulmonary support (PCPS) has proven to be a valuable technique in high-risk coronary patients undergoing percutaneous coronary intervention (PCI). However, there have been few studies on PCI associated with PCPS in Korea. We summarized our experience with PCPS-supported PCI.Subjects and MethodsWe retrospectively reviewed 19 patients with PCPS-supported PCI between August 2005 and June 2009. PCPS was used as an elective procedure for 10 patients with at least two of the following conditions: left-ventricular ejection fraction <35%, target vessel(s) supplying more than 50% of the viable myocardium, high risk surgical patients, and patients who refused coronary bypass surgery. In the remaining 9 patients PCPS was used as an emergency procedure, to stabilize and even resuscitate patients with acute myocardial infarction and cardiogenic shock, in order to attempt urgent PCI.ResultsAmong the 19 patients who were treated with PCPS-supported PCI, 11 (57.9%) survived and 8 (42.1%) patients did not. ST elevation myocardial infarction with cardiogenic shock was more prevalent in the non-survivors than in the survivors (75% vs. 27.3%, p=0.04). The elective PCPS-supported PCI was practiced more frequently in the survivors than in the non-survivors (72.7% vs. 25%, p=0.04). In the analysis of the event-free survival curve between elective and emergency procedures, there was a significant difference in the survival rate (p=0.025). Among the survivors there were more patients with multi-vessel disease, but a lower Thrombolysis in Myocardial Infarction grade in the culprit lesions was detected in the non-survivors, before PCI. Although we studied high-risk patients, there was no procedure-related mortality.ConclusionOur experience suggests that PCPS may be helpful in high risk patients treated with PCI, especially in elective cases. More aggressive and larger scale studies of PCPS should follow.

Outcomes of a modified, low-cost, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) for elective, periprocedural support of high-risk percutaneous cardiac interventions: An experience from a latinamerican center

“…A retrospective analysis of prophylactic versus standby cardiopulmonary support for high-risk PCI showed greater procedural morbidity -mainly vascular access-related complicationsin the former (41% vs. 9.4%, p < 0.01) but higher procedural mortality in the latter (4.8% vs. 18.8%, p < 0.05). 11 The remainder evidence is limited to case series including few patients undergoing either PCI [12][13][14][15][16][17][18][19][20] or TAVI, 9,10 with only one paper reporting outcomes in a mixed (coronary and structural) group of patients. 20 All of them achieved good results, but most with a significant rate of vascular access-related complications.…”

The Role of Hemodynamic Support in High-risk Percutaneous Coronary Intervention

“…The increase in afterload may contribute to LV distention, elevated LVEDP, increased myocardial oxygen demand, and an ultimate decline in myocardial perfusion in patients with significant LV dysfunction. 36 Limited data for VA-ECMO use in HR-PCI suggest feasibility, [37][38][39][40][41] although vascular and renal complications remain a significant concern ( Table 3).…”