Abstract
PurposeComplex 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.MethodsA two-centre, retrospective study was performed of all patients undergoing high-risk PCI and receiving VA-ECMO for cardiopulmonary support.ResultsA 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.ConclusionVA-ECMO in high-risk PCI is feasible with a good outcome. It can be successfully used for cardiopulmonary support in selected patients.
Highlights
Patients with stable complex coronary artery disease, e.g. three-vessel disease, left main coronary artery disease or one or more chronic total occlusions (CTO), who need revascularisation can be treated with either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) [1]
The current study aims at describing patient characteristics, procedural findings and outcome in the use of VA-extracorporeal membrane oxygenation (ECMO) for mechanical circulatory support in elective high-risk PCI
In neither of the two participating centres was a form of mechanical circulatory support other than VA-ECMO available at the time that was capable of providing full mechanical circulatory support
Summary
Patients with stable complex coronary artery disease, e.g. three-vessel disease, left main coronary artery disease or one or more chronic total occlusions (CTO), who need revascularisation can be treated with either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) [1]. These cases are discussed by a heart team, whereby several risk stratification scores can be used to determine the risk of either form of revascularisation and a wellconsidered decision made about the most appropriate revascularisation strategy [1]. Guidelines still advise the use of CABG rather than PCI [1]
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