Cardiopulmonary bypass support of high risk coronary angioplasty patients: registry results.

Coronary angioplasty has been increasingly utilized in patients with extensive coronary disease, severe and acute chest pain syndromes, and poor ventricular function. This process has been facilitated in part by use of circulatory support, including perfusion balloons, intraaortic balloon pumps and cardiopulmonary bypass support systems. Percutaneous cannulation has facilitated elective and emergency application of cardiopulmonary bypass support in patients undergoing high risk coronary angioplasty. A National Registry of 25 centers has accumulated data on 801 elective and 210 emergency support angioplasty patients. Standby cardiopulmonary bypass support of elective high risk patients was associated with fewer complications and less in-hospital mortality in patients other than those with left ventricular ejection fraction < or = 20% and possibly older high risk patients. In elective cases, circulatory support was required in only approximately 7% of high risk patients, although need appeared to be unpredictable. Emergency use of cardiopulmonary bypass support, initiated < 20 minutes from the time of circulatory collapse, was associated with improved patient prognosis. Overall, patients undergoing circulatory cardiopulmonary bypass supported angioplasty had a marked reduction in anginal status, improvement in left ventricular ejection fraction and good (80%) 2-year survival. Although used only occasionally, circulatory support remains an important prophylactic interventional tool for the extremely high risk patient (left ventricular ejection fraction < or = 20%) and a lifesaving emergency technique for the occasional patient with circulatory collapse.