Percutaneous Approach to Cardiopulmonary Bypass Support in the Cardiac Catheterization Laboratory View PDF

Temporary cardiopulmonary support in the catheterization laboratory using percutaneous approach, ranging from intra-aortic balloon counterpulsation to full oxygenator pumps for cardiopulmonary bypass, has long been part of the interventional toolbox [1-2]. Different bypass systems are commercially available, including a transseptal left atrial inflow system (Tandem Heart®, Cardiac Assist, Inc., Pittsburgh, Pennsylvania), a retrograde transaortic pump (Impella®, Abiomed, Inc., Danvers, Massachusetts), and “conventional” right atrial and distal aortic percutaneous bypass (Percutaneous cardiopulmonary bypass, CPS) also known as Veno- arterial Extracorporeal membrane oxygenation (ECMO) [3]. Each has advantages and disadvantages. The Tandem Heart does not require an oxygenator but requires operators to be skilled in transseptal access and is perhaps most difficult to deploy in emergencies. The Impella requires only arterial access but requires transaortic access to the left ventricle. Percutaneous cardiopulmonary bypass requires arterial (of adequate caliber) and venous access but is straightforward to deploy during cardiopulmonary resuscitation while chest compressions are uninterrupted [4]. Prophylactic application of these aggressive support systems has waned at many clinical centers as coronary interventional tools have matured, especially in the form of highly deliverable stents.