Hemodynamically supported percutaneous coronary revascularization improves left ventricular function in patients with ischemic dilated cardiomyopathy at very high risk for surgery: a single-center experience.
BACKGROUND
Coronary artery bypass grafting is often considered for patients with ischemic cardiomyopathy, but age, comorbidities and depressed left ventricular function can increase surgical risk. Percutaneous left ventricular assist devices (pLVAD) may facilitate complex percutaneous coronary interventions (PCI) in the setting of severely impaired left ventricular function, thus providing a possible alternative to thoracotomy in high-risk patients. The long-term effects of hemodynamically-supported PCI on left ventricular function and clinical outcome in these patients are poorly understood.


OBJECTIVE
To determine the effect of hemodynamically-supported multivessel PCI on left ventricular ejection fraction (LVEF) in patients with severe ischemic cardiomyopathy at very high operative risk.


METHODS
Retrospective case-series analysis of patients with ischemic cardiomyopathy at very high surgical risk who underwent prophylactic pLVAD implantation for hemodynamic support during complex PCI between January 2004 and February 2007. The main outcome variable was change in LVEF assessed by echocardiography 90 days or more after PCI. Major in-hospital adverse cardiovascular events (MACE), vascular complications and all-cause mortality were secondary endpoints.


RESULTS
Eleven patients with prior myocardial infarction and ischemic cardiomyopathy (mean age 73 +/- 14 years) underwent TandemHeart-supported PCI. The indications for prophylactic support were depressed LVEF and a large myocardial mass at risk. Baseline LVEF was 25 +/- 8%, increasing to 41 +/- 9% at a mean follow-up time of 15 +/- 15 months (p = 0.0004). There were no in-hospital MACE and only 1 vascular complication requiring blood transfusion.


CONCLUSIONS
PLVAD-supported PCI in patients with ischemic cardiomyopathy at very high risk for surgery is feasible and relatively safe. In combination with medical therapy, it results in significant improvement in LVEF by echocardiography.
Gimelli
Giorgio
G
Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA. gxg@medicine.wisc.edu
Wolff
Matthew R
MR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome; D016277:Ventricular Function, Left