International Society For Minimally Invasive Cardiothoracic Surgery

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Minimal Invasive Percutaneous Technique For Implantation And Ablation Of Peripheral Venoarterial Extracorporal Membrane Oxygenation
ALEXANDRE PELOUZE, KAMRAN AHMADOV, MARCO ROFFI, STEPHANE NOBLE, KARIM BENDJELID, RAPHAEL GIRAUD, CHRISTOPH HUBER, MUSTAFA CIKIRIKCIOGLU.
UNIVERSITY HOSPITAL OF GENEVA, GENEVA, Switzerland.

Objectives: Veno-arterial (VA), peripheral, extracorporeal membrane oxygenation (ECMO) is used for assistance in high-risk percutaneous procedures and support of hemodynamically unstable or life threatening conditions. Percutaneous implantation is a preferred method however percutaneous ablation is not routinely performed. We report a minimal invasive-total percutaneous technique used on temporary or long term VA-ECMO support. Methods: Following surgical disinfection and wrapping, ultrasonography guided puncture of the common femoral artery and vein was performed according to Seldinger technique. Suture mediated vascular closure devices-VCD (Prostar® or Proglide® Abbott Vascular- Ireland) was inserted and positioned before implantation of the arterial and venous ECMO cannulas. Distal reperfusion cannulas were used only for long-term supported patients (> 6 hours). Position of venous cannula in the right atrium was confirmed by fluoroscopy or trans-thoracic echocardiography. During ECMO cannulas’ ablation the VCD devices were used to control haemostasis. Results: Between January 2014 and December 2017, minimal invasive-total percutaneous technique was performed on 13 patients (9 for temporary support - high risk percutaneous coronary intervention and / or trans-aortic valve implantation interventions, 3 for long term support of heart failure patients). The mean age was 72.3 years (45-91 years). Four of the patients were female and 9 male. We did observe neither peri-interventional complication nor conversion to surgical ablation or hospital mortality (Table 1). Conclusions: Minimal invasive-total percutaneous technique is feasible and safe for implantation and ablation of peripheral veno-arterial extra-corporal membrane oxygenation, on selected patients. Systemic inflammatory response syndrome (SIRS) is one of the main concerns during ECMO treatment. We believe minimal invasive-total percutaneous technique may decrease SIRS response on fragile patients and may accelerate their recovery.



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