[Coronary angioplasty in an Italian hospital without on-site cardiac surgery: the results and outlook].

BACKGROUND

The concept of the absolute need of surgical standby for coronary angioplasty, although still strongly supported by the Task Force of the AHA and ACC, has been changing over the years according to the developments of PTCA equipment and the introduction of autoperfusion balloon catheters and coronary stents. In many European countries and in Canada, due to the relative lack of institutions performing cardiac surgery, almost 40% of cardiac laboratories are now performing PTCA without on-site surgical standby.

METHODS AND RESULTS

Following a previous experience in another institution with on-site cardiac surgery, since January 1991 until February 1994, 742 Patients underwent PTCA in our Hospital not provided with on-site cardiac surgery. Surgical standby was requested in 99 cases to nearby surgical centers and it was utilized in 6 cases. Primary success was achieved in 91% of stenoses (94% in non occlusive and 69% in totally occlusive lesions). The mortality rate in cases other than cardiogenic shock was 0.13%, the myocardial infarction rate was 1.2% and the rate of emergency coronary bypass operation was 0.8%.

CONCLUSIONS

PTCA in our view, as well as others', can be successfully performed in Institutions without on-site surgical support, provided the cardiac team has achieved a satisfactory experience and skill, the correct equipment for treatment of occlusive complications is available and a nearby surgical institution is alerted for procedures considered at particular risk, due to the amount of myocardium in jeopardy in case of irreversible arterial occlusion.