The role of mechanical support devices during percutaneous coronary intervention.

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS JRSM Cardiovascular Disease Pub Date : 2021-10-19 eCollection Date: 2021-01-01 DOI:10.1177/20480040211014064
Ritesh Kanyal, Jonathan Byrne
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Abstract

The practice of interventional cardiology has changed dramatically over the last four decades since Andreas Gruentzig carried out the first balloon angioplasty. The obvious technological improvements in stent design and interventional techniques have facilitated the routine treatment of a higher risk cohort of patients, including those with complex coronary artery disease and poor left ventricular function, and more often in the setting of cardiogenic shock (CS) complicating acute myocardial infarction (AMI). The use of mechanical cardiac support (MCS) in these settings has been the subject of intense interest, particularly over the past decade . A number of commercially available devices now add to the interventional cardiologist's armamentarium when faced with the critically unwell or high-risk patient in the cardiac catheter laboratory. The theoretical advantage of such devices in these settings is clear- an increase in cardiac output and hence mean arterial pressure, with variable effects on coronary blood flow. In doing so, they have the potential to prevent the downward cascade of ischaemia and hypoperfusion, but there is a paucity of evidence to support their routine use in any patient subset, even those presenting with cardiogenic shock. This review will discuss the use and haemodynamic effect of MCS devices during percutaneous coronary intervention (PCI), and also examine the clinical evidence for their use in patients with cardiogenic shock, and those undergoing 'high risk' PCI.

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机械支持装置在经皮冠状动脉介入治疗中的作用。
自安德烈亚斯-格伦茨格(Andreas Gruentzig)实施首例球囊血管成形术以来,介入心脏病学的实践在过去四十年中发生了巨大变化。支架设计和介入技术的明显技术改进促进了对更高风险患者群的常规治疗,其中包括患有复杂冠状动脉疾病和左心室功能不佳的患者,以及更常见的急性心肌梗死(AMI)并发心源性休克(CS)患者。在这些情况下使用机械心脏支持(MCS)引起了人们的强烈兴趣,尤其是在过去十年中。面对心导管实验室中的危重病人或高危病人,许多商业化设备为介入心脏病专家增添了新的武器。在这些情况下,此类设备的理论优势显而易见--增加心输出量,从而增加平均动脉压,并对冠状动脉血流产生不同的影响。这样,它们就有可能防止缺血和低灌注的下行级联反应,但支持在任何患者亚群(甚至是出现心源性休克的患者)中常规使用这些设备的证据却很少。本综述将讨论 MCS 装置在经皮冠状动脉介入治疗(PCI)期间的使用情况和血流动力学效应,并研究其在心源性休克患者和接受 "高风险 "PCI 患者中使用的临床证据。
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来源期刊
JRSM Cardiovascular Disease
JRSM Cardiovascular Disease CARDIAC & CARDIOVASCULAR SYSTEMS-
自引率
6.20%
发文量
12
审稿时长
12 weeks
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