Percutaneous left atrial to femoral arterial bypass pumping for circulatory support in high‐risk coronary angioplasty

Abstract

Left atrial to femoral arterial bypass was evaluated as a means of supporting patients who were considered to be at high risk for the performance of percutaneous transluminal coronary angioplasty. A 20 French drainage catheter was inserted percutaneously into the left atrium via a modified transseptal technique. Blood was withdrawn from the left atrium and returned through a femoral arterial cannula using a roller pump. Thirteen patients were treated in this fashion with excellent circulatory support. Pump flows varied from 1.5 to 3 liters per minute and bypass time ranged from 27 to 106 min (mean = 43 +/- 17). Aortic mean pressure was well supported during balloon inflation. No significant complications were encountered. Neither an oxygenator nor a perfusionist is required. The ability to obtain direct left ventricular decompression offers a major potential advantage. Further evaluation of this technique for the support of such patients is indicated.

Percutaneous Left Ventricular Assist Devices: Clinical Uses, Future Applications, and Anesthetic Considerations

“…It was not until the 1990s when the transfemoral percutaneous approach of this type of circulatory support for patients undergoing high-risk coronary interventions was described for short-term use. 14 The TandemHeart is a new generation of low-speed centrifugal continuous-flow pump that has been approved for shortterm (6 hours) circulatory support by the Food and Drug Administration, 12 although it has been used for days for hemodynamic support. These characteristics result in a theoretic reduction of hemolysis and thrombus formation.…”

Reversal of Cardiogenic Shock by Percutaneous Left Atrial-to-Femoral Arterial Bypass Assistance

“…12,13 Currently, there are only few reports of totally percutaneous approaches in which the VAD was implanted in the catheterization laboratory setting for patients undergoing high-risk interventions with a mean operating time of 43 minutes or in two patients for cardiogenic shock. 14,15 However, until now, this technique has not achieved widespread popularity as a circulatory support because of the lack of a transseptal cannula that can accommodate the flow rates necessary to provide adequate circulatory support for long-term clinical use. Furthermore, the pumps used so far were operated at a higher speed and were not provided with an additional housing assembly, which allows the high local concentration of anticoagulant within the pump and avoids warming up.…”