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Outcome Of Va Ecmo On Assistance In Patients Undergoing High-risk Percutaneous Coronary Revascularisation
Sanjay Kumar, MCh,FRCS1, Vladamir Shumaster, MD
2;
1Institute of Medical Sciences, Banaras Hindu University, Varanasi, India,
2Yale New Haven Hospital, New Haven, CT, USA
BACKGROUND: The haemodynamic instability during Complex high-risk percutaneous coronary intervention (PCI)may lead to increased morbidity and mortality. Pre-emptive use of Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can provide cardiopulmonary support in high-risk PCI and may lead to improved survival.
METHODS:We performed a retrospective analysis of all patients undergoing high-risk PCI who received peri-procedural VA-ECMO for cardiopulmonary support.
RESULTS: A total of 11 patients (90% male, median age 67 (53-83) years), of whom 60% 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 between January 2013 and December2019. Cannulation was femoral-femoral in all patients. 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 29.7 (10-40.5) 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). 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 20%(2), with one patient developing a transient ischaemic attack post-ECMO and other one developed a thrombus in the femoral vein used for ECMO cannulation.
CONCLUSIONS:VA-ECMO in high-risk PCI can be successfully used for cardiopulmonary support in selected patients with a good outcome.
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