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Reduction of myocardial ischemia during percutaneous transluminal coronary angioplasty with oxygenated Fluosol®

1990; Elsevier BV; Volume: 66; Issue: 3 Linguagem: Inglês

10.1016/0002-9149(90)90836-p

1879-1913

Kenneth M. Kent, Michael Cleman, Michael J. Cowley, Mervyn B. Forman, C. Carl Jaffe, Marvin A. Kaplan, Spencer B. King, Mitchell W. Krucoff, Thomas Lassar, Bruce J. McAuley, Rafael Smith, Charlene Wisdom, Daniel Wohlgelernter,

Cardiac, Anesthesia and Surgical Outcomes

Abstract The effects of perfusion of an oxygen-carrying perfluorochemical emulsion (Fluosol ® ) in alleviating symptoms of myocardial ischemia during balloon occlusion were examined in a multicenter trial of 245 patients. Severe anginal pain occurred less frequently in patients receiving Fluosol perfusion (21%) than in those receiving routine angioplasty (34%) (p < 0.05). ST-segment changes at balloon deflation in routine angioplasty patients were significantly greater than in patients who received oxygenated Fluosol perfusion (2.2 ± 1.2 vs 1.7 ± 0.9 mm; p < 0.03). Profound regional wall dysfunction (−561 ± 224 U) was observed in routine angioplasty patients by 2-dimensional echocardiography. Patients receiving oxygenated Fluosol perfusion, however, maintained near baseline levels of ventricular function (−61 ± 335 U) during occlusion (p < 0.0001). Mean global left ventricular ejection fraction was preserved at baseline levels during balloon inflation in patients perfused with oxygenated Fluosol but decreased significantly (p < 0.001) during occlusion in routine angioplasty patients. A total of 26 complications (19 routine group; 7 perfusion group) was reported. Adverse responses to the perfusate were infrequent, occurring in 1.6 and 2.0% of patients after the test dose and during perfusion, respectively. Thus, transcatheter perfusion with an oxygen-carrying perfluorochemical emulsion is effective in alleviating myocardial ischemia during angioplasty and can be safely administered in this patient population.