PROPHYLACTIC CARDIOPULMONARY SUPPORT IN H IGH-RISK PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

With improved technology and development of several mechanical assist devices, the indications of percutaneous transluminal coronary revascu larization have been extended. In 39 patients (30 men, mean age = 60.1 . +/- 8.1 years) with angina pectoris or heart failure, with poor oper ative risk-benefit ratio and ejection fraction < 35 % and/or target ve ssel supplying > 50 % of the viable myocardium, we performed assisted percutaneous transluminal coronary revascularization. Intraortic ballo on counterpulsation (n = 16), extracorporal circulation (n = 21), or h emopump (n = 2) were used for mechanical support. Complete 6-week foll ow up was possible in 27 patients. An improvement of left-ventricular function (patients with EF less than or equal to 35 % demonstrated an improvement: 27 +/- 7 vs 36 +/- 10 %, p < 0.05),heart failure (patient s with EF less than or equal to 35 % demonstrated an improvement of ma ximal oxygen uptake: 14 +/- 4 vs 17 +/- 4 ml/kg/min; p < 0.05) and a m arked improvement of angina (23/38 demonstrated CCS-improvement of at least one class) was found. Hospital mortality was as low as 2.6 %. Ma jor postinterventional complications included nonfatal myocardial infa rction (n = 2), fatal retroperitoneal bleeding (n = 1), pulmonary edem a (n = 1), nonfatal ventricular fibrillation (n = 1), cerebrovascular event without residual (n = 1), and deep vein thrombosis (n = 4). In c onclusion, assisted percutaneous revascularization was successful in a high risk subset of patients with increased surgical risk and/or poor ventricular function.