title: Diagnostic and therapeutic percutaneous cardiac interventions without on-site surgical backup--review of 11 years experience.
abstract: BACKGROUND
  Current clinical guidelines restrict catheterization laboratory activity without on-site surgical backup. Recent improvements in technical equipment and pharmacologic adjunctive therapy increase the safety margins of diagnostic and therapeutic cardiac catheterization.
  
  
  OBJECTIVE
  To analyze the reasons for urgent cardiac surgery and mortality in the different phases of our laboratory's activity in the last 11 years, and examine the impact of the new interventional and therapeutic modalities on the current need for on-site cardiac surgical backup.
  
  
  METHODS
  We retrospectively reviewed the mortality and need for urgent cardiac surgery (up to 12 hours post-catheterization) through five phases of our laboratory's activity: a) diagnostic (years 1989-2000), b) valvuloplasties and other non-coronary interventions (1990-2000), c) percutaneous-only balloon angioplasty (1992-1994), d) coronary stenting (1994-2000), and e) use of IIb/IIIa antagonists and thienopiridine drugs (1996-2000).
  
  
  RESULTS
  Forty-eight patients (0.45%) required urgent cardiac surgery during phase 1, of whom 40 (83%) had acute coronary syndromes with left main coronary artery stenosis or the equivalent, and 8 (17%) had mechanical complications of acute myocardial infarction. Two patients died (0.02%) during diagnostic procedures. In phase 2, eight patients (2.9%) were referred for urgent cardiac surgery due to either cardiac tamponade or severe mitral regurgitation, and two patients (0.7%) died. The combined need for urgent surgery and mortality was significantly lower in phase 4 plus 5 as compared to phase 3 (3% vs. 0.85%, P = 0.006).
  
  
  CONCLUSIONS
  In the current era using coronary stents and potent antithrombotic drugs, after gaining experience and crossing the learning curve limits, complex cardiac therapeutic interventions can safely be performed without on-site surgical backup.
authors.affiliation: Department of Cardiology, HaEmek Medical Center, Afula, Israel. yoav_t@clalit.org.il
authors.forename: Yoav
authors.initials: Y
authors.lastname: Turgeman
authors.forename: Shaul
authors.initials: S
authors.lastname: Atar
authors.forename: Khalid
authors.initials: K
authors.lastname: Suleiman
authors.forename: Alexander
authors.initials: A
authors.lastname: Feldman
authors.forename: Lev
authors.initials: L
authors.lastname: Bloch
authors.forename: Nahum A
authors.initials: NA
authors.lastname: Freedberg
authors.forename: Dante
authors.initials: D
authors.lastname: Antonelli
authors.forename: Mohamed
authors.initials: M
authors.lastname: Jabaren
authors.forename: Tiberio
authors.initials: T
authors.lastname: Rosenfeld
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization / Q000009:adverse effects*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents
chemical_list: D005343:Fibrinolytic Agents