Percutaneous cardiopulmonary support in critical patients needing coronary interventions with stents

Abstract

Percutaneous cardiopulmonary support (CPS) has proven to be a technique of value in high-risk coronary patients undergoing percutaneous balloon angioplasty. Since May 1994, we have combined the use of CPS and coronary stent revascularization in 92 patients. In 68 of them, the CPS was used as a prophylactic procedure (group 1); in the remaining 24, the CPS was used as an emergency procedure to stabilize and even resuscitate patients with acute myocardial infarction and circulatory collapse, in order to attempt urgent percutaneous coronary stent treatment (group 2). Primary success was achieved in 66 patients from group 1 (97%). One patient died and another had a myocardial infarction. After 28 +/- 19 months of follow-up, 20 patients (30%) from group 1 had a major adverse cardiac event. The remaining 46 patients (68%) are alive, with persistent clinical benefit. In group 2, reperfusion and stent treatment was always achieved. However, 14 patients had an in-hospital death. Five patients from group 2 had a major adverse event at follow-up (47 +/- 20 months). Nine patients (38%) remain at present in functional class I-II. Percutaneous CPS provides safe conditions to accomplish stent coronary revascularization in high-risk patients and those with acute myocardial infarction and failing heart. Long-term follow-up of survivors shows persistent benefit in most patients.