Efficacy and safety of percutaneous life support during high-risk percutaneous coronary intervention, refractory cardiogenic shock and in-laboratory cardiopulmonary arrest.

BACKGROUND

High-risk percutaneous coronary interventions (PCI), refractory cardiogenic shock and in-lab cardiac arrest are all associated with significant mortality. Percutaneous left ventricular assist devices (pLVAD) and CPS (cardiopulmonary support) have been used to support such patients. However, the extent to which the use of these devices can improve outcomes in this patient subset is not known.

METHODS

We evaluated clinical features, efficacy and safety outcomes in a retrospective cohort of 39 patients, treated either with pLVAD or CPS for support of high-risk PCI, cardiogenic shock or in-lab cardiac arrest. The Tandem-Heart and a new versatile Multifunctional Percutaneous Heart (MPH) system, with both CPS and LVAD capability, were used and assessed.

RESULTS

19 patients received the TandemHeart and 20 received the MPH system. The MPH system was used as a pLVAD in 12 and to provide CPS in 8 patients. Procedural efficacy was 100%. Emergent institution of CPS, in the setting of cardiac arrest, was able to support 7 out of 8 patients and resulted in a 50% survival to hospital discharge rate. Overall, in-hospital death and 30-day major adverse cardiac event rates were 28.2% and 35.9%, respectively. The risk of vascular complications and bleeding was relatively small.

CONCLUSIONS

pLVADs are effective in supporting patients during high-risk cardiac (coronary and structural heart) interventions, with a low risk of device-related complications. Further, the expeditious use of CPS in the catheterization laboratory can improve survival in a selected subset of patients with refractory cardiogenic shock and cardiac arrest.