Pyka Lukasz, Szkodzinski Janusz, Piegza Jacek, Swietlińska Malgorzata, Gąsior Mariusz
3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
Department of Cardiology, Scanmed Center of Cardiology, Chorzow, Poland.
Front Cardiovasc Med. 2023 Jun 23;10:1169165. doi: 10.3389/fcvm.2023.1169165. eCollection 2023.
Recently published studies suggest that percutaneous coronary intervention (PCI) has no significant impact on outcomes in patients with heart failure and stable coronary artery disease. The use of percutaneous mechanical circulatory support is growing, but its value is still uncertain. If large areas of viable myocardium are ischemic, the benefit from revascularization should be evident. In such instances, we should strive for complete revascularization. The use of mechanical circulatory support in such cases is vital because it provides hemodynamic stability throughout the complex procedure.
We present a case of a 53-year-old male heart transplant candidate with type 1 diabetes mellitus, initially considered unsuitable for revascularization and qualified for heart transplantation, transferred to our center due to acute decompensated heart failure. At this time, the patient had temporary contraindications for heart transplantation. As the patient was considered no-option, we have decided to reassess the possibility of revascularization. The heart team opted for a high-risk mechanically supported PCI with the aim of complete revascularization. A complex multivessel PCI was performed with optimal effect. The patient was weaned off dobutamine on the second day post-PCI. Four months post-discharge, he remains stable, is in NYHA II class, and has no chest pain. Control echocardiography showed improved ejection fraction. The patient is not a heart transplant candidate anymore.
This case report shows that we must strive for revascularization in select heart failure cases. The outcome of this patient suggests that heart transplant candidates with potentially viable myocardium should be considered for revascularization, especially as the shortage of donors persists. In the most complex coronary anatomy and severe heart failure, mechanical support in the procedure might be essential.
最近发表的研究表明，经皮冠状动脉介入治疗（PCI）对心力衰竭合并稳定型冠状动脉疾病患者的预后没有显著影响。经皮机械循环支持的应用正在增加，但其价值仍不确定。如果大面积存活心肌缺血，血运重建的益处应该是明显的。在这种情况下，我们应努力实现完全血运重建。在此类病例中使用机械循环支持至关重要，因为它在整个复杂手术过程中提供血流动力学稳定性。
我们报告一例53岁男性，患有1型糖尿病，最初被认为不适合进行血运重建且符合心脏移植条件，因急性失代偿性心力衰竭转至我院。此时，该患者存在心脏移植的临时禁忌证。由于该患者被认为没有其他选择，我们决定重新评估血运重建的可能性。心脏团队选择了高风险的机械支持PCI，目标是实现完全血运重建。进行了复杂的多支血管PCI，效果理想。患者在PCI术后第二天停用了多巴酚丁胺。出院后四个月，他情况稳定，纽约心脏协会（NYHA）心功能分级为II级，无胸痛症状。超声心动图检查显示射血分数有所改善。该患者不再是心脏移植候选人。
本病例报告表明，在某些心力衰竭病例中我们必须努力进行血运重建。该患者的结果表明，对于可能存在存活心肌的心脏移植候选人应考虑进行血运重建，尤其是在供体短缺持续存在的情况下。在最复杂的冠状动脉解剖结构和严重心力衰竭的情况下，手术中的机械支持可能至关重要。
