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

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          Abstract

          Background and Objectives

          Percutaneous 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 Methods

          We 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.

          Results

          Among 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.

          Conclusion

          Our 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.

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          Most cited references21

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          Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung.

          F GERBODE, Joanna Murray, Jonathan Bramson … (1972)
          Article 0 comments Cited 167 times – based on 0 reviews     Review now
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            Review of ECMO (extra corporeal membrane oxygenation) support in critically ill adult patients.

            Silvana Marasco, George Lukas, Michael McDonald … (2008)
            Mechanical circulatory support has evolved markedly over recent years. ECMO (extra corporeal membrane oxygenation) is instituted for the management of life threatening pulmonary or cardiac failure (or both), when no other form of treatment has been or is likely to be successful. Most commonly, it is instituted in an emergency or urgent situation after failure of other treatment modalities. It is used as temporary support, usually awaiting recovery of organs, or can be used as a bridge to a more permanent device or cardiac transplantation. ECMO can be deployed in a veno-arterial configuration (either peripheral or central cannulation) for the treatment of cardiogenic shock. This is usually seen post-cardiotomy, post-heart transplant and in severe cardiac failure due to almost any other cause (e.g. cardiomyopathy, myocarditis, acute coronary syndrome with cardiogenic shock). Veno-venous ECMO is used for respiratory failure and usually involves peripheral cannulation using the femoral veins+/-internal jugular vein if required. The indications for veno-venous ECMO are respiratory failure, most commonly due to adult respiratory distress syndrome (ARDS), pneumonia, trauma or primary graft failure following lung transplantation. ECMO is also used for neonatal and paediatric respiratory support. Its use in premature neonates is the mainstay of treatment for immature lungs and insufficient surfactant. In this review, the technical aspects of ECMO cannulation, maintenance and weaning are outlined. Complication rates and outcomes are reviewed and our experience at The Epworth Hospital is summarized.
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              Prophylactic versus standby cardiopulmonary support for high risk percutaneous transluminal coronary angioplasty.

              Paul S Teirstein, Robert A Vogel, Gerald Dorros … (1993)
              Data from a national registry of 23 centers using cardiopulmonary support (CPS) were analyzed to compare the risks and benefits of prophylactic CPS versus standby CPS for patients undergoing high risk coronary angioplasty. Early data from the CPS registry documented a high angioplasty success rate as well as a high procedural morbidity rate. Because of this increased morbidity some high risk patients were placed on standby CPS instead of prophylactic CPS. Patients in the prophylactic CPS group had 18F or 20F venous and arterial cannulas inserted and cardiopulmonary bypass initiated. Patients in the standby CPS group were prepared for institution of cardiopulmonary bypass, but bypass was not actually initiated unless the patient sustained irreversible hemodynamic compromise. There were 389 patients in the prophylactic CPS group and 180 in the standby CPS group. The groups were comparable with respect to most baseline characteristics, except that left ventricular ejection fraction was lower in the prophylactic CPS group. Thirteen of the 180 patients in the standby CPS group sustained irreversible hemodynamic compromise during the angioplasty procedure. Emergency institution of CPS was successfully initiated in 12 of these 13 patients in < 5 min. Procedural success was 88.7% for the prophylactic and 84.4% for the standby CPS group (p = NS). Major complications did not differ between groups. However, 42% of patients in the prophylactic CPS group sustained femoral access site complications or required blood transfusions, compared with only 11.7% of patients in the standby CPS group (p < 0.01). Among patients with an ejection fraction < or = 20%, procedural morbidity remained significantly higher in the prophylactic CPS group (41% vs. 9.4%, p < 0.01), but procedural mortality was higher in the standby group (4.8% vs. 18.8%, p < 0.05). Patients in the standby and prophylactic CPS groups had comparable success and major complication rates, but procedural morbidity was higher in the prophylactic group. When required, standby CPS established immediate hemodynamic support during most angioplasty complications. For most patients, standby CPS was preferable to prophylactic CPS during high risk coronary angioplasty. However, patients with extremely depressed left ventricular function (ejection fraction < 20%) may benefit from institution of prophylactic CPS.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean Circ J
                Journal ID (publisher-id): KCJ
                Title: Korean Circulation Journal
                Publisher: The Korean Society of Cardiology
                ISSN (Print): 1738-5520
                ISSN (Electronic): 1738-5555
                Publication date (Print): June 2011
                Publication date (Electronic): 30 June 2011
                Volume: 41
                Issue: 6
                Pages: 299-303
                Affiliations
                Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea.
                Author notes
                Correspondence: Yangsoo Jang, MD, Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 120-752, Korea. Tel: 82-2-2228-8210, Fax: 82-2-393-2041, jangys1212@ 123456yuhs.ac
                Article
                DOI: 10.4070/kcj.2011.41.6.299
                PMC ID: 3132690
                PubMed ID: 21779281
                SO-VID: c68201bb-bf69-4344-94c0-a15d772a2e5e
                Copyright © Copyright © 2011 The Korean Society of Cardiology
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 31 May 2010
                Date revision received : 03 September 2010
                Date accepted : 11 September 2010
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: shock, cardiogenic
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: shock, cardiogenic

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