EMERGENCY PERCUTANEOUS CARDIOPULMONARY BYPASS SUPPORT FOR ACUTE MYOCARDIAL-INFARCTION

We assessed the efficacy of emergency percutaneous cardiopulmonary byp ass support (PCPS) in the treatment of patients with acute myocardial infarction complicated by cardiogenic shock. Emergency PCPS was instit uted in 21 consecutive patients beginning in 1991, After the stabiliza tion of the hemodynamics, coronary reperfusion was performed by means of coronary artery bypass grafting or percutaneous transluminal corona ry angioplasty. Of the seven patients with acute myocardial infarction involving either the left main or two-vessel territories, five surviv ed more than 1 month, but only one patient remained alive and well aft er 20 months. The main cause of death for this group was low output sy ndrome. Four of 12 patients with acute left main trunkal occlusion in the catheter laboratory survived and showed a preserved cardiac functi on (mean followup 28.5 months). The main cause of death for this group was brain damage. Two patients with single-vessel territory acute myo cardial infarction underwent PCPS to treat refractory ventricular fibr illation. Both patients were still alive and well at a 12-month follow up. Percutaneous cardiopulmonary bypass support successfully stabilize d the hemodynamics, allowing time to perform revascularization for all three groups of patients with life-threatening acute myocardial infar ction. Recanalization was nevertheless unable to salvage the damaged m yocardium in cases of prolonged ischemic time.