Utility of standby cardiopulmonary support for elective coronary interventions

Abstract

At our institution, elective coronary interventions are performed without formal surgical backup. Instead, a policy of “standby cardiopulmonary support” (CPS), and “next‐available operating room” is used. Standby CPS requires a perfusionist dedicated to the catheterization laboratory with immediate access to CPS apparatus. Between January 1989 and June 1994 we performed 2,850 elective coronary interventions. Eleven patients (0.4%) required emergency CPS. None of these patients fell into a high‐risk category for PTCA (i.e., sole circulation, ejection fraction <20%, unprotected left main). Eight of these (73%) had completion of their coronary intervention while on CPS in the catheterization laboratory. Three patients were sustained on CPS until an operating room became available. All patients required blood transfusions and sustained non–Q‐wave myocardial infarctions. Two late in‐hospital deaths occurred. Nine patients (82%) were successfully discharged. Standby CPS provides hemodynamic support for patients who sustain a potentially catastrophic event during coronary intervention. Our data suggest that this modality should not be limited to high‐risk patients. Cathet. Cardiovasc. Intervent. 46:32–35, 1999. © 1999 Wiley‐Liss, Inc.

Cardiopulmonary support during electrophysiological procedures for ventricular tachycardias not haemodynamically tolerated

“…8 On interruption of CPS, there is a risk of myocardial stunning because of the increased afterload, expecially for patients with depressed left ventricular function and coronary artery disease. 3 In our experience, this risk is greatly reduced by limiting the period of support to intervals of 15 ]/20 min. A major limit to the use of CPS during electrophysiological procedures is the economic burden and the availability of a perfusion service.…”

Percutaneous Cardiopulmonary Support for Catheter Ablation of Unstable Ventricular Arrhythmias in High-Risk Patients

“…A relevant experience has been acquired about the use of CPS to protect high-risk patients undergoing coronary angioplasty from myocardial ischemia [11][12][13][14]. Our exclusive experience refers to the use of CPS as assistant device to enable CA in patients with unstable VTs; it indicates that CPS may assure stability for a reasonable time to perform activation mapping, thus improving CA safety and success.…”

“…The percutaneous cardiopulmonary support (CPS) has been originally described in the heart catheter laboratory for complex interventional revascularization procedures [11][12][13][14]; its use has been more recently proposed by our group as a support for emergency CA in patients with nontolerated VT [15]. The aim of our study is to retrospectively evaluate overall feasibility and clinical outcome of CPS in a selected population of high-risk patients undergoing CA for unstable VT between 1999 and 2008.…”

Hybrid Therapies for Ventricular Arrhythmias

“…Percutaneous cardiopulmonary support (pCPS) has proven to be a technique of value in high risk coronary patients undergoing percutaneous balloon angioplasty and in the management of cardiac emergencies characterized by acute lowering of cardiac output 28–30 …”

“…Percutaneous cardiopulmonary support (pCPS) has proven to be a technique of value in high risk coronary patients undergoing percutaneous balloon angioplasty and in the management of cardiac emergencies characterized by acute lowering of cardiac output. [28][29][30] RFCA coupled with pCPS system has been attempted in one emergency setting (incessant sustained untolerated VT) in a series of 17 consecutive patients at our institution. In all cases the arrhythmia was related to coronary artery disease, idiopathic dilated cardiomyopathy, or arrhythmogenic right ventricular dysplasia.…”