Changing trends for surgical standby in patients undergoing percutaneous transluminal coronary angioplasty.
In 1988 the American College of Cardiology/American Heart Association (ACC/AHA) task force subcommittee on Guidelines for Percutaneous Transluminal Coronary Angioplasty (PTCA) recommended that an experienced cardiovascular surgical team be available within the institution for emergency surgery for all angioplasty procedures. The subcommittee felt strongly that this requirement allowed for no exception, stating that it could not condone existing arrangements that required the transportation of patients to off-site surgical facilities for emergency cardiac surgery. Such arrangements failed to meet the necessary standards of care exercised by prudent physicians. Interventional cardiologists are recognizing that it may be prudent for the ACC/AHA task force to revise its 1988 guidelines. Improved operator technique and new technologic advances, such as lasers, atherectomy devices, stents, and perfusion pumps and balloons, have helped extend the reach of PTCA to more seriously ill patients. With new technologies for angioplasty and an increased awareness of risk factors, active standby can be markedly reduced, thereby resulting in enormous cost reductions and in more appropriate patient care.
Vogel
J H
JH
Santa Barbara Heart and Lung Institute, Goleta Valley Community Hospital, California.
D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000639:trends; D001026:Coronary Artery Bypass / Q000379:methods / Q000639:trends*; D006801:Humans; D010818:Practice Patterns, Physicians'