Percutaneous Cardiopulmonary Bypass Research Articles

Anesthesia for robotic cardiac surgery: An amalgam of technology and skill

The surgical procedures performed with robtic assitance and the scope for its future assistance is endless. To keep pace with the developing technologies in this field it is imperative for the cardiac anesthesiologists to have aworking knowledge of these systems, recognize potential complications and formulate an anesthetic plan to provide safe patient care. Challenges posed by the use of robotic systems include, long surgical times, problems with one lung anesthesia in presence of coronary artery disease, minimally invasive percutaneous cardiopulmonary bypass management and expertise in Trans-Esophageal Echocardiography. A long list of cardiac surgeries are performed with the use of robotic assistance, and the list is continuously growing as surgical innovation crosses new boundaries. Current research in robotic cardiac surgery like beating heart off pump intracardic repair, prototype epicardial crawling device, robotic fetal techniques etc. are in the stage of animal experimentation, but holds a lot of promise in future.

Extracorporeal circulatory systems in the interhospital transfer of critically ill patients: experience of a single institution

BACKGROUND AND OBJECTIVES:Critically ill patients with acute circulatory failure cannot be moved to other institutions unless stabilized by mechanical support systems. Extracorporeal heart and lung assist systems are increasingly used as a bridge to end-organ recovery or transplantation, and as an ultimate rescue tool in cardiopulmonary resuscitation.PATIENTS AND METHODS:From July 2001 to April 2008, we had 38 requests for extracorporeal support for interhospital transfer carried out by the air medical service. Respiratory failure was present in 29 patients, who were provided with pumpless extracorporeal lung assist (PECLA) or veno-venous extracorporeal membrane oxygenation (ECMO). Cardiac failure dominated in 9 patients, who underwent implantation of extracorporeal life support (ECLS). Underlying diseases were acute respiratory distress syndrome in 15 patients, pneumonia in 7, prior lung transplant status in 4, cardiogenic shock in 7, and septic shock in 4.RESULTS:All assist systems were connected via peripheral vessels by the Seldinger technique. Transport was uneventful in all cases with no technical failures. On arrival at the specialized care hospital, two patients had leg ischemia and underwent relocation of the arterial cannula. After a mean (SD) support of 5.1 (3.0) days for PECLA, 3.5 (2.9) days for ECLS, and 7.3 (5.8) days for ECMO, 60%, 66%, and 66% of patients, respectively, could be successfully weaned from the systems. Discharge rates were 45% for PECLA, 44% for ECLS, and 56% for ECMO.CONCLUSION:Our experience proves that minimized extracorporeal assist devices allow safe assistance of patients with isolated or combined heart and lung failure in need of interhospital transfer. Critically ill patients get a chance to reach a center of maximum medical care.

Pheochromocytoma-Induced Cardiogenic Shock Rescued by Percutaneous Cardiopulmonary Bypass System

Pheochromocytoma is a rare cause of cardiogenic shock. Clinical management is directed at reducing the heart rate while maintaining blood pressure. However, medical treatment is often unsuccessful because of the high endogenous catecholamine level and low cardiac output. Percutaneous cardiopulmonary bypass system is a circulatory device that allows for safer use of heart-rate-reducing agents, which is advantageous when used early in the course of the cardiogenic shock induced by pheochromocytoma.

The Efficacy of Rewarming With a Portable and Percutaneous Cardiopulmonary Bypass System in Accidental Deep Hypothermia Patients With Hemodynamic Instability

Accidental deep hypothermia (ADH)--a condition in which the core body temperature is less than 28 degrees C--is a medical emergency; the mortality rates for ADH remain high. The efficacy of cardiopulmonary bypass (CPB) rewarming has been proved in ADH patients with cardiopulmonary arrest; however, its efficacy in the ADH patients without cardiopulmonary arrest remains controversial. In our study, we evaluated the efficacy of portable percutaneous cardiopulmonary bypass (PPCPB) for rewarming and providing cardiovascular support in the hemodynamically unstable ADH patients without cardiopulmonary arrest. Between April 2001 and March 2006, we performed a retrospective study at Tokai University, Kanagawa, Japan. We studied 24 ADH patients without cardiopulmonary arrest (male:female ratio, 15:9; mean age, 68.5 +/- 12.9 years) with hemodynamic instability who had not developed intracranial hemorrhage. We evaluated the efficacy of PPCPB rewarming by estimating the mean time of initiation of PPCPB after admission, rewarming speed, the success rate of rewarming, the rate of weaning from PPCPB, the incidence of ventricular fibrillation (Vf) during rewarming, complications associated with PPCPB, mortality rate, and the Glasgow Outcome Scale (GOS) scores of the patients who survived. The mean time of initiation of PPCPB after admission was 41.9 +/- 7.9 minutes. The rewarming speed was 4.0 +/- 1.5 degrees C/h. A 100% success rate was achieved after the rewarming procedure, whereas the rate of weaning from PPCPB was 91.7%. Vf during rewarming developed in one case; however, electrical defibrillation was possible. No direct complications of PPCPB were observed. The mortality rate was 12.5% (3/24). The GOS scores of the patients who survived were as follows: 5 points, 17 cases; 4 points, 3 cases; and 3 points, 1 case. PPCPB rewarming is a clinically efficacious procedure for rewarming and providing cardiovascular support in hemodynamically unstable ADH patients without cardiopulmonary arrest who have not developed intracranial hemorrhage.

Abstract 2052: A Rapid Cooling of The Brain Using Percutaneous Cardiopulmonary Bypass Significantly Improves Neurological Function in Patients with Out-of-Hospital Cardiogenic Cardiac Arrest

Objectives: Neurological recovery in patients (pts) with out-of-hospital cardiogenic cardiac arrest (OHCCA) is affected by the cerebral circulatory collapse time from the cardiac arrest to the return of spontaneous circulation. According to recent studies, the cerebral circulatory collapse time is estimated to be 30 min. or less in order to successfully recover neurologically. In addition, percutaneous cardiopulmonary bypass (PCPB) is a powerful tool for rescuing the pts with OHCCA refractory to advanced cardiovascular life support (ACLS), and we have been positively performing cardiopulmonary cerebral resuscitation and rapidly cooling of the brain using PCPB. In this treatment, the cerebral circulatory collapse time is the duration from cardiac arrest to the start of PCPB, we discovered the fact that there are many neurologically successful cases of recovery even though the cerebral circulatory collapse time has exceeded 30 min. In the present study, we investigated the neurological prognosis in relation to the cerebral circulatory collapse time. Methods: From January 2006 to April 2008, 77 consecutive pts with OHCCA, who have been treated with brain hypothermia at 34 degree C were included. 77 pts were divided into two groups. Brain hypothermia (BH) groups (n=34) were treated with only brain hypothermia after the return of spontaneous circulation, and PCPB groups (n=33) were treated with hypothermia using PCPB against refractory to ACLS. The relation between the cerebral circulatory collapse time and the neurological prognosis were assessed. Results: The cerebral circulatory collapse time were from 8 min. to 78 min. in the BH groups, whereas it lasted from 22 min. to 91 min. in PCPB groups. In BH groups, the cases with the favorite neurological outcome were 23 cases (67.6%) and the average collapse time was 19.2 min. (8 to 35 min.) In contrast, in the PCPB groups, the successful neurological cases were 15 cases (45.5%), the average collapse time was 43.6 min (22 to 60 min.) In the cases who received PCPB, there were cases of neurologically successful prognoses even though the cerebral circulatory collapse time was long. Conclusions: These results suggest that a rapid cooling of the brain using PCPB permits a cerebral circulatory collapse time.

Ethical challenges with the left ventricular assist device as a destination therapy.

The left ventricular assist device was originally designed to be surgically implanted as a bridge to transplantation for patients with chronic end-stage heart failure. On the basis of the REMATCH trial, the US Food and Drug Administration and the US Centers for Medicare & Medicaid Services approved permanent implantation of the left ventricular assist device as a destination therapy in Medicare beneficiaries who are not candidates for heart transplantation. The use of the left ventricular assist device as a destination therapy raises certain ethical challenges. Left ventricular assist devices can prolong the survival of average recipients compared with optimal medical management of chronic end-stage heart failure. However, the overall quality of life can be adversely affected in some recipients because of serious infections, neurologic complications, and device malfunction. Left ventricular assist devices alter end-of-life trajectories. The caregivers of recipients may experience significant burden (e.g., poor physical health, depression, anxiety, and posttraumatic stress disorder) from destination therapy with left ventricular assist devices. There are also social and financial ramifications for recipients and their families. We advocate early utilization of a palliative care approach and outline prerequisite conditions so that consenting for the use of a left ventricular assist device as a destination therapy is a well informed process. These conditions include: (1) direct participation of a multidisciplinary care team, including palliative care specialists, (2) a concise plan of care for anticipated device-related complications, (3) careful surveillance and counseling for caregiver burden, (4) advance-care planning for anticipated end-of-life trajectories and timing of device deactivation, and (5) a plan to address the long-term financial burden on patients, families, and caregivers.Short-term mechanical circulatory devices (e.g. percutaneous cardiopulmonary bypass, percutaneous ventricular assist devices, etc.) can be initiated in emergency situations as a bridge to permanent implantation of ventricular assist devices in chronic end-stage heart failure. In the absence of first-person (patient) consent, presumed consent or surrogate consent should be used cautiously for the initiation of short-term mechanical circulatory devices in emergency situations as a bridge to permanent implantation of left ventricular assist devices. Future clinical studies of destination therapy with left ventricular assist devices should include measures of recipients' quality of end-of-life care and caregivers' burden.

Bridge to Decision: Twenty Year Experience with Urgent Percutaneous Cardiopulmonary Bypass for Salvage of Potential Survivors of Refractory Cardiovascular Collapse

Bridge to Decision: Twenty Year Experience with Urgent Percutaneous Cardiopulmonary Bypass for Salvage of Potential Survivors of Refractory Cardiovascular Collapse

Cardiogenic shock following nasal septoplasty: a case report and review of the literature

Nasal septoplasty is a surgical procedure offered to patients with chronic snoring secondary to nasal obstruction. We describe a case of cardiogenic shock following the administration of metoprolol to treat hypertension, (likely) induced by systemic absorption of topical epinephrine used during a routine nasal septoplasty. A 29-yr-old male, with no significant medical history, was scheduled for nasal septoplasty for mild nasal obstruction. Following routine anesthetic induction, cotton balls, soaked with epinephrine (1:1000), were applied to the nasal mucosa. The patient became hypertensive with a blood pressure of 207/123 mmHg. Intravenous metoprolol was administered. Severe pulmonary edema ensued, with resulting hypoxic respiratory failure and cardiogenic shock. The patient was transferred to a tertiary care facility for percutaneous cardiopulmonary bypass. After five days of cardiopulmonary bypass support and six weeks of intensive care monitoring, the patient's cardiac status returned to normal limits. A hypertensive response, following systemically absorbed topical vasoconstrictors, including both phenylephrine and epinephrine, can be associated with dire consequences when treated with a beta-adrenergic blocking drug and, possibly, calcium channel blockers. To prevent severe complications including; pulmonary edema, cardiogenic shock, cardiac arrest, and, possibly, death, these drug interactions need to be appreciated.

First experiences with a new miniaturised life support system for mobile percutaneous cardiopulmonary bypass

As a result of healthcare changes, interhospital transfer has become common in the care even of patients with severely deteriorated cardiopulmonary function. This study describes experience with the use of a specially downsized, lightweight extracorporeal circulation system (Emergency-MECC) which enables percutaneous cardiopulmonary bypass support in resistant cases of severe cardiac and cardiopulmonary failure. Between March 2006 and June 2007, the Emergency-MECC system, consisting of a centrifugal pump and a membrane oxygenator, was used to facilitate interhospital transfer of five adults. The technique included percutaneous cannulation, femoro-femoral venoarterial (n=4) and femoro-jugular venovenous (n=1) life support by extracorporeal membrane oxygenation. Bedside cannulation was uneventful and the extracorporeal circulation support achieved adequate systemic blood flow and oxygen delivery in all cases. Vasopressor support could be immediately reduced and hypoxaemia was treated effectively. During interhospital transfer (air ambulance in three and ground ambulance in two cases), no technical complication occurred. Hospital survival rate was 80%. The Emergency-MECC system is safe, rapid and highly effective in restoring blood flow and oxygen delivery. Interhospital transfer on cardiopulmonary bypass was made possible without extended technical or personnel support.

A novel miniaturised extracorporeal circulation system for emergency percutaneous cardiopulmonary bypass in acute heart failure

A novel miniaturised extracorporeal circulation system for emergency percutaneous cardiopulmonary bypass in acute heart failure

Abstract 2010: A Pre-hospital Percutaneous Cardiopulmonary Bypass Order Treatment Strategy Significantly Improves Neurological Function in Patients with Out-of-Hospital Cardiogenic Cardiopulmonary Arrest

Objectives: Percutaneous cardiopulmonary bypass (PCPB) is a powerful tool for rescuing the emergency patients (pts) with out-of-hospital cardiogenic cardiac arrest (OHCCA), who are not responding to advanced cardiovascular life support (ACLS). But the system under which the decision to apply PCPB is made at the hospital and preparations then made could exceed the time limitations imposed for cerebral resuscitation. Thus, we have collaborated with the physician-manned ambulance system, and we introduced a pre-hospital PCPB order treatment strategy for patients with out-of-hospital cardiogenic cardiopulmonary arrest, who do not respond to drug administration or electrical cardioversion. Methods: In 174 pts with OHCA treated with PCPB in a single institution, from April 1991 to May 2007. 135 consecutive pts with cardiogenic cardiac arrest refractory to ACLS, who had been treated with PCPB, were included. 135 Pts were divided into two groups. Pre-hospital order groups (n=42) were treated under the pre-hospital PCPB order system, and in-hospital order groups (n=93) were treated under the decision to initiate PCPB was made at the hospital. Rate of return of spontaneous circulation (ROSC), weaning of PCPB, survival to discharge, and favorable neurological recovery were assessed. Results: Pre-hospital order groups showed increases in ROSC, weaning of PCPB, survival to discharge, and significant increases in favorable neurological recovery compared to in-hospital order groups. Conclusions: These results suggest that a pre-hospital PCPB order treatment strategy for patients after CPA significantly improves the neurological function in pts with OHCCA. Table

Near-fatal betaxolol self-poisoning treated with percutaneous extracorporeal life support

We present a case of successful treatment of near-fatal beta-blocker self-poisoning but requiring extracorporeal circulatory support with severe complications. A 38-year-old woman ingested a mixture of tablets including betaxolol (5.32 g). Despite intensive treatment with fluid, dobutamine, isoprenaline, epinephrine, nor-epinephrine and glucagon, sustained cardiogenic shock occurred with almost complete hypokinesia of the left ventricular 14 h later. Therefore, a cardiac support was performed with a percutaneous cardiopulmonary bypass device at bedside. We review the literature with emphasis on both the best time to start this technique and its complications.

Bronchofiberoscopic Diagnosis of Bronchial Disruption and Pneumonectomy Using a Percutaneous Cardio-Pulmonary Bypass System

Bronchofiberoscopic Diagnosis of Bronchial Disruption and Pneumonectomy Using a Percutaneous Cardio-Pulmonary Bypass System

Choc peranesthésique d'étiologie probablement anaphylactique à l'atracurium traité avec succès par circulation extracorporelle

We report the case of a 55-year-old woman ASA 2 scheduled for a cholecystectomy, who presented 25 minutes after the induction, a circulatory arrest probably due to a cardiac anaphylaxis attributed to atracurium. After 60 minutes of futile resuscitation without any spontaneous cardiac rhythm a percutaneous cardiopulmonary bypass (CPB) was initiated. Twenty minutes later and after three external electric shocks electric cardiac activity returned normal. The weaning was possible 120 minutes later with catecholamine support. She left the intensive care unit on postoperative day seven after a laparotomy secondary to splenic injury due to intensive cardiopulmonary resuscitation. She was discharged home without any neurologic or cardiac sequellae. Biological assessment done during the circulatory arrest and cutaneous tests performed ten weeks later confirmed an isolated allergy to atracurium. CPB is the most efficient support in case of reversible cardiac arrest but unfortunately the less accessible outside from cardiac surgery unit.

Pressure criterion for placement of distal perfusion catheter to prevent limb ischemia during adult extracorporeal life support

Pressure criterion for placement of distal perfusion catheter to prevent limb ischemia during adult extracorporeal life support

Lepirudin: a bivalent direct thrombin inhibitor for anticoagulation therapy

Lepirudin (Refludan®, Berlex Laboratories, USA and Canada; Pharmion®, all other countries), a recombinant derivative of the naturally occurring leech anticoagulant hirudin, was the first direct thrombin inhibitor to be approved by the European Agency for the Evaluation of Medicinal Products and the US Food and Drug Administration for the treatment of heparin-induced thrombocytopenia. Since its introduction into Europe and the USA, it has been studied in over 7000 patients requiring anticoagulation in conditions including acute coronary syndromes, percutaneous coronary intervention, cardiopulmonary bypass and heparin-induced thrombocytopenia. Three European clinical trials, designated Heparin-Associated Thrombocytopenia (HAT)-1, -2 and -3, demonstrated the efficacy and safety of lepirudin in the prevention and treatment of thrombosis in patients with antibody-confirmed heparin-induced thrombocytopenia. A postmarketing, observational study, termed the Drug-Monitoring Program, evaluated lepirudin in over 1000 patients with heparin-induced thrombocytopenia in the setting of routine clinical practice. In the Drug-Monitoring Program, adverse events were substantially reduced compared with clinical trials, while clinical efficacy was maintained; suggesting that insight gained through clinical experience was translated into improved safety. Here, pharmacotherapy using lepirudin is reviewed, with particular reference to clinical studies in heparin-induced thrombocytopenia, and some recommendations based on this extensive clinical experience with lepirudin are provided. Although only approved for the treatment of heparin-induced thrombocytopenia, the use of lepirudin in acute coronary syndromes, percutaneous coronary intervention, vascular surgery and coronary artery bypass grafting is also discussed. The review concludes with a discussion of pharmacokinetic and clinical data supporting the potential for subcutaneous administration of lepirudin.

Outcome of the perioperative use of percutaneous cardiopulmonary support for adult cardiac surgery: factors affecting hospital mortality.

Percutaneous cardiopulmonary bypass support (PCPS) has become a widespread standard modality for the treatment of circulatory collapse; however, its clinical use for postcardiotomy low cardiac output syndrome (LOS) has been reported to be unsatisfactory. We reviewed the clinical outcomes of twenty-three patients undergoing cardiac surgery and treated with PCPS. Solitary coronary artery grafting was undertaken for nine patients, while three had concomitant procedures. The remaining patients underwent valvular surgery. The indications for PCPS were preoperative shock in two patients and postcardiotomy LOS or shock in twenty-one patients. All patients except one underwent an intraaortic balloon pump. Sixteen of the twenty-three patients (69.6%) were weaned from PCPS and twelve patients (52.2%) reached hospital discharge. A univariate analysis revealed that risk factors for hospital mortality were age older than seventy years (P = 0.05), PCPS running time (P = 0.017), low cardiac function at the institution of PCPS (P = 0.004), and urine output within the initial 24 h (P = 0.041). The cardiac index (CI) in survivors was improved within 24 h, and eleven of the twelve survivors were weaned off PCPS within 48 h, whereas ten of the twelve nonsurvivors required PCPS for more than 48 h (P = 0.0006). There is little possibility of weaning patients from PCPS who do not show any signs of hemodynamic recovery within 48 h after its institution. Limited use of PCPS within 48 h may be applicable for postcardiotomy patients, but other cardiopulmonary support, such as a left ventricular assist device, may be required when hemodynamic recovery is not obtained within 48 h.

Experience with percutaneous venoarterial cardiopulmonary bypass for emergency circulatory support*

Mechanical circulatory support can maintain vital organ perfusion in patients with cardiac failure unresponsive to standard pharmacologic treatment. The purpose of the current study was to report complication and survival rates in patients supported with emergency percutaneous venoarterial cardiopulmonary bypass because of prolonged cardiogenic shock or cardiopulmonary arrest. Retrospective clinical study. A total of 46 patients supported with venoarterial cardiopulmonary bypass, 25 because of cardiogenic shock unresponsive to pharmacologic therapy and 21 because of cardiopulmonary arrest unresponsive to standard advanced cardiac life support. In 41 of the 46 patients (89%), stable extracorporeal circulation was established; in five patients (11%), femoral cannulation was accomplished only after a surgical cutdown. A total of 28 patients were weaned from cardiopulmonary bypass (19 of 25 patients with cardiogenic shock vs. 9 of 21 patients with cardiopulmonary arrest, p =.03), and 13 patients had long-term survival (10 of 25 patients with cardiogenic shock vs. 3 of 21 patients with cardiopulmonary arrest, p =.1). Complications directly related to the use of cardiopulmonary bypass were found in 18 patients (39%), major complications related to femoral cannulation being the most common single cause for bypass-associated morbidity (eight patients, 17%). Long-term survival rates after emergency percutaneous cardiopulmonary bypass are encouraging in patients with an underlying cardiocirculatory disease amenable to immediate corrective intervention (angioplasty, surgery, transplantation).

Favorable clinical outcome in patients with cardiogenic shock due to fulminant myocarditis supported by extracorporeal membrane oxygenation: Comparison with those with acute (nonfulminant) myocarditis

Yasuhide Asaumi, Satoshi Yasuda, lsao Morii, Hiroyuki Kakuchi, Yoritaka Otsuka, Atsushi Kawamura, Hiroshi Nonogi, Yoshikado Sasako, Shunichi Miyazaki, National Cardiovascular Center, Suita, Japan Background: The application of extracorporeal membrane oxygenation (ECMO) wtth percutaneous cardiopulmonary bypass has been recently extended to temporaiy circula- tory support in patients with fulminant myocarditis. However, the survival and prognosis of patients who are particularly ill remain poorly understood. Methods: Patients with myocarditis were divided into the following two groups. Fourteen patients who required ECMO for cardiogenic shock were defined as having fulminant myocarditis (F group), whereas 13 patients who had acute onset of symptoms but did not have compromised hemodynamics were defined as having acute (nonfulminant) myocarditis (non-F group). Results: In F group, 10 patients were successfully weaned from ECMO. Therefore, the overall survival rate at the time of discharge was 71%. Between patients who died (D) and those survived (S) in F group. there were significant differences (PcO.05) in left ven- tricular end-diastolic dimension (D:36& vs S:50*2 [mean&EM] mm), end-systolic dimension (D:34+6 vs S:45+2mm), wall thickness (D:15+1 vs S:l lilmm). maxCPK-MB levels (D:353*145 vs S:120+35U/L) and serum creatinine levels (D:2.1*0.5 vs S:l.O+O.lmg/dl). Compared with the non-F group, the fractional shortening in the F group was more severely depressed in the acute phase (F:lOil vs non-F:23*3%, P<O.O5), but recovered in the chronic phase (F:30*2 vs non-F:33*3%, P=NS). Rates for adverse clin- ical events were also similar between the F and non-F groups during the follow-up period of 36 months on average. Conclusions: In patients with fulminant myocarditis, a hemo- dynamic support using ECMO results in excellent swival. Once a patient recovers from inflammatory myocardial damage, the subsequent clinical outcome is favorable, similar to that observed in patients with acute (nonfulminant) myocardltis. 1208-66

Usefulness of percutaneous left ventricular assistance to support high-risk percutaneous coronary interventions

Percutaneous coronary intervention (PCI) has been proposed as a measure to alleviate symptoms and improve prognosis in patients with atherosclerotic heart disease and depressed heart function. Nonetheless, the risk of ischemic complications during or after the procedure is potentially increased in these patients. A number of supportive techniques have been described for high-risk angioplasty 1 Shawl F.A. Quyyumi A.A. Bajaj S. Hoff S.B. Dougherty K.G. Percutaneous cardiopulmonary bypass-supported coronary angioplasty in patients with unstable angina pectoris or myocardial infarction and a left ventricular ejection fraction ≤25%. Am J Cardiol. 1996; 77: 14-19 Abstract Full Text PDF PubMed Scopus (25) Google Scholar , 2 Scholz K.H. Dubois-Rande J.L. Urban P. Morice M.C. Loisance D. Smalling R.W. Figulla H.R. Clinical experience with the percutaneous hemopump during high-risk coronary angioplasty. Am J Cardiol. 1998; 82: 1107-1110 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar , 3 Dubois-Rande J.L. Teiger E. Garot J. Aptecar E. Pernes J.M. Tixier D. Gueret P. Loisance D. Dupouy P. Effects of the 14F hemopump on coronary hemodynamics in patients undergoing high-risk coronary angioplasty. Am Heart J. 1998; 135: 844-849 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar , 4 Schreiber T.L. Kodali U.R. O’Neill W.W. Gangadharan V. Puchrowicz-Ochocki S.B. Grines C.L. Comparison of acute results of prophylactic intraaortic balloon pumping with cardiopulmonary support for percutaneous transluminal coronary angioplasty (PCTA). Cathet Cardiovasc Diagn. 1998; 45: 115-119 Crossref PubMed Scopus (22) Google Scholar , 5 Kaul U. Sahay S. Bahl V.K. Sharma S. Wasir H.S. Venugopal P. Coronary angioplasty in high risk patients comparison of elective intraaortic balloon pump and percutaneous cardiopulmonary bypass support—a randomized study. J Interv Cardiol. 1995; 8: 199-205 Crossref PubMed Scopus (18) Google Scholar ; however, no single approach has achieved wide acceptance. Limited effectiveness in the actual support 6 Taguchi I. Ogawa K. Oida A. Abe S. Kaneko N. Sakio H. Comparison of hemodynamic effects of enhanced external counterpulsation and intra-aortic balloon pumping in patients with acute myocardial infarction. Am J Cardiol. 2000; 86: 1139-1141 Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar and device-related complications 2 Scholz K.H. Dubois-Rande J.L. Urban P. Morice M.C. Loisance D. Smalling R.W. Figulla H.R. Clinical experience with the percutaneous hemopump during high-risk coronary angioplasty. Am J Cardiol. 1998; 82: 1107-1110 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar , 4 Schreiber T.L. Kodali U.R. O’Neill W.W. Gangadharan V. Puchrowicz-Ochocki S.B. Grines C.L. Comparison of acute results of prophylactic intraaortic balloon pumping with cardiopulmonary support for percutaneous transluminal coronary angioplasty (PCTA). Cathet Cardiovasc Diagn. 1998; 45: 115-119 Crossref PubMed Scopus (22) Google Scholar , 7 Alderman J.D. Gabliani G.I. McCabe C.H. Brewer C.C. Lorell B.H. Pasternak R.C. Skillman J.J. Steer M.L. Baim D.S. Incidence and management of limb ischemia with percutaneous wire-guided intraaortic balloon catheters. J Am Coll Cardiol. 1987; 9: 524-530 Abstract Full Text PDF PubMed Scopus (87) Google Scholar have hampered a more widespread use of these methods. Recently, a newly developed percutaneous left ventricular assist device (pVAD) has been demonstrated to effectively reverse cardiogenic shock after myocardial infarction (Tandem Heart pVAD; Cardiac Assist Technologies, Inc., Ithaca, New York). 8 Thiele H. Lauer B. Hambrecht R. Boudriot E. Cohen H.A. Schuler G. Reversal of cardiogenic shock by percutaneous left atrial-to-femoral arterial bypass assistance. Circulation. 2001; 104: 2917-2922 Crossref PubMed Scopus (233) Google Scholar This system is readily deployed by percutaneous approach in the catheterization laboratory and is able to provide a systemic output of up to 4 L/min. An inflow cannula is inserted into the left atrium via transseptal puncture and the oxygenated blood is diverted to the femoral artery by a low-speed centrifugal continuous-flow pump. In this study, we report on a series of patients who underwent high-risk PCI supported by the Tandem Heart pVAD.