Diagnostic and therapeutic percutaneous cardiac interventions without on-site surgical backup--review of 11 years experience.
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.
Turgeman
Yoav
Y
Department of Cardiology, HaEmek Medical Center, Afula, Israel. yoav_t@clalit.org.il
Atar
Shaul
S
Suleiman
Khalid
K
Feldman
Alexander
A
Bloch
Lev
L
Freedberg
Nahum A
NA
Antonelli
Dante
D
Jabaren
Mohamed
M
Rosenfeld
Tiberio
T
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
D005343:Fibrinolytic Agents