TCT-633 Presentation Management and Outcomes of Acute Right Ventricular Failure and Cardiogenic Shock After Right Ventricle Marginal Branch Occlusion During Chronic Total Occlusion Percutaneous Intervention

Document Type

Conference Proceeding

Publication Date

10-24-2023

Publication Title

J Am Coll Cardiol

Abstract

Background: Cardiogenic shock (CS) complicating acute right ventricle (RV) branches occlusion during right coronary artery (RCA) chronic total occlusion percutaneous intervention (CTO PCI) is rare but life-threatening. The initial presentation is variable, and the diagnosis might be missed without invasive hemodynamic measurements. Methods: Among 1,415 CTO PCI procedures performed in 1,183 patients between September 13, 2014, and May 24, 2023, at our hospital, 10 patients had RV marginal branch occlusion complicated by CS. The baseline patient characteristics, procedural details, hemodynamics, management, and outcomes were retrospectively collected. Results: The incidence of CS caused by RV marginal branch occlusion after CTO PCI was 0.7% of all CTO PCIs and 1.32% of RCA CTO PCIs. The target vessel was the dominant RCA in all patients. 9 were men, 8 were White, 1 was Black, and 1 was Hispanic. 5 patients had a prior history of CABG, and 3 had end-stage renal disease requiring hemodialysis. None of the patients had baseline RV dysfunction. All procedures were performed under monitored anesthesia care, procedural success was achieved in 9 patients, the crossing technique was antegrade dissection and re-entry in 1 patient, and retrograde wiring with reverse controlled antegrade and retrograde tracking in 8 patients. Acute marginal branch occlusion occurred in all patients. 4 patients had coronary artery perforation, 2 developed tamponade requiring pericardiocentesis, and 2 had small RV free wall hematoma. Cardiac arrest was the initial presentation in 8 patients, profound RV failure requiring RV mechanical support was present in all patients, and 5 patients needed additional LV support. The mortality rate was 30% (3 patients). The mechanism of RV failure was occlusion of the acute marginal branches during the procedure in all patients. The average RV MCS support duration was 5.3 days. Conclusion: CS complicating RV marginal branches occlusion during RCA CTO PCI is associated with a 30% mortality rate. The initial presentation was cardiac arrest in 80%. All patients required RV MCS support. Early invasive hemodynamic measurement is necessary to make the diagnosis. Preservation of the RV marginal branches is essential to prevent this complication. Categories: CORONARY: Complex and Higher Risk Procedures for indicated Patients (CHIP)

Volume

82

First Page

B254-B255

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