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2017, Number 1

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Rev Sanid Milit Mex 2017; 71 (1)

Utility of containment balloon in refractory cardiogenic shock secondary to acute anteroapical myocardial infarction

Gutiérrez-Leonard H, Hernández-Casas AS, Galván-Vargas CG, Ramírez-Aldaraca MÁ, Fuentes-Córdova BA, Meneses-Bonilla A, Torres-Alarcón CG

Language: Spanish
References: 21
Page: 42-51
PDF size: 346.70 Kb.


ABSTRACT

Background: Coronary artery disease is the most common single cause of death in all countries of the world, corresponding to 12.8% of all deaths. Complications in the acute phase may lead the patient to a state of cardiogenic shock being the leading cause of death in patients hospitalized for acute myocardial infarction with 50% mortality despite reperfusion therapy, optimal medical treatment and intraaortic balloon support.
Objective: To reduce mortality secondary to cardiogenic shock due to anteroapical ST-segment elevation acute myocardial infarction (STEMI).
Materials and methods: We included patients with anteorapical STEMI who coronary blood flow was restored by primary angioplasty and continue with cardiogenic shock despite various supportive therapies. By angioplasty technique the "containment balloon", an angioplasty balloon was placed on the left anterior descending artery, which was the diameter according to the vessel and 80 mm in length covering the entire course of the artery and it was inflated with contrast undiluted, leaving it for 12 hours, new measurements were made (pulmonary capillary wedge pressure, cardiac index) with the pulmonary artery catheter during this time. At the end of 12 hours the balloon was deflated and removed from the coronary, then bare metal stents were placed distal to proximal.
Reslts: In this study we observed higher mortality with standard treatment than the reported in the literature. However, making an intervention with the containment balloon this mortality is reduced by 66.6 % (p<0.01) in the control group. It could be demonstrated an increase in ejection fraction at 48 hours average of 34% (p ‹ 0.01) in patients treated by containment balloon.
Conclusion It is a novel, useful, reproducible and no learning curve technique with superior survival benefit in patients with cardiogenic shock due to anteroapical STEMI. The cost of this technique is less than the cost of different ventricular assist devices.


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