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

• Published in: Netherlands heart journal Vol. 28; no. 3; pp. 139 - 144
• Main Authors: van den Brink, F. S., Meijers, T. A., Hofma, S. H., van Boven, A. J., Nap, A., Vonk, A., Symersky, P., Sjauw, K. D., Knaapen, P.
• Format: Journal Article
• Language: English
• Published: Houten Bohn Stafleu van Loghum 01.03.2020; Springer Nature B.V
• Subjects: Angioplasty; Cardiology; Cardiovascular disease; Coronary vessels; Diabetes; Ejection fraction; Extracorporeal membrane oxygenation; Heart failure; Heart surgery; Hemoglobin; Hypertension; Intensive care; Intervention; Ischemia; Medical Education; Medicine; Medicine & Public Health; Mortality; Original; Original Article; Patients; Vein & artery diseases; High-risk percutaneous coronary intervention; Percutaneous coronary intervention; Chronic total occlusion; Veno-arterial extracorporeal membrane oxygenation
• ISSN: 1568-5888; 1876-6250
• DOI: 10.1007/s12471-019-01350-8

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.