Prophylactic veno-arterial extracorporeal membrane oxygenation in patients undergoing high-risk percutaneous coronary intervention

F S van den Brink, T A Meijers, S H Hofma, A J van Boven, A Nap, A Vonk, P Symersky, K D Sjauw, P Knaapen, F S van den Brink, T A Meijers, S H Hofma, A J van Boven, A Nap, A Vonk, P Symersky, K D Sjauw, P Knaapen

Abstract

Purpose: Complex high-risk percutaneous coronary intervention (PCI) is challenging and frequently accompanied by haemodynamic instability. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can provide cardiopulmonary support in high-risk PCI. However, the outcome is unclear.

Methods: A two-centre, retrospective study was performed of all patients undergoing high-risk PCI and receiving VA-ECMO for cardiopulmonary support.

Results: A total of 14 patients (92% male, median age 69 (53-83) years), of whom 50% had previous coronary artery disease in the form of a coronary artery bypass graft (36%) and a PCI (14%) underwent high-risk PCI and received VA-ECMO support. The main target lesion was a left main coronary artery in 78%, a left anterior descending artery in 14%, a right coronary artery in 7%, and 71% underwent multi-vessel PCI in addition to main target vessel PCI. The median SYNTAX score was 27.2 (8-42.5) and in 64% (9/14) there was a chronic total occlusion. Left ventricular function was mildly impaired in 7% (1/14), moderately impaired in 14% (2/14) and severely impaired in 64% (9/14). Cannulation was femoral-femoral in all patients. Median ECMO run was 2.57 h (1-4). Survival was 93% (13/14). One patient died during hospitalisation due to refractory cardiac failure. All other patients survived to discharge. Complications occurred in 14% (2/14), with one patient developing a transient ischaemic attack post-ECMO and one patient developing a thrombus in the femoral vein used for ECMO cannulation.

Conclusion: VA-ECMO in high-risk PCI is feasible with a good outcome. It can be successfully used for cardiopulmonary support in selected patients.

Keywords: Chronic total occlusion; High-risk percutaneous coronary intervention; Percutaneous coronary intervention; Veno-arterial extracorporeal membrane oxygenation.

Conflict of interest statement

F.S. van den Brink, T.A. Meijers, S.H. Hofma, A.J. van Boven, A. Nap, A. Vonk, P. Symersky, K.D. Sjauw and P. Knaapen declare that they have no competing interests.

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Source: PubMed

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