Veno-Arterial Extracorporeal Membrane Oxygenation in Elective High-Risk Percutaneous Coronary Interventions

Bai, Ming; Lu, Andong; Pan, Chenliang; Hu, Sixiong; Qu, Wenjing; Zhao, Jing; Zhang, Bo

doi:10.3389/fmed.2022.913403

Cited by 14 publications

(13 citation statements)

References 35 publications

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“…eGFR pre-procedure were 67.22 ± 26.85 and post-procedure minimum 60.09 ± 27.78 (<0.002), Before PCI LVEF was 38.69 ± 13.65 and after PCI were 43.55 ± 13.72 (p<0.001) [3,4] In SYNTAX trials, results from ten years post-revascularization allcause mortality in PCI and CABG, no difference amongst both [2]. In this study HR-PCI triple vessels revascularization in CABG patients was successful but they were very limited in comparison to others in terms longer survival duration and no MACCE events post HR-PCI, Bai et al reported in their study, they formed a subgroup of patients underwent ECMO in elective HR-PCI that triple vessel in CABG patient survival rate was higher as compared to other PCI procedure but in left main stenosis PCI and CABG were same survival rate [21]. Revascularization stratagem in left main or triple vessel coronary artery disease patients were evaluated by cardiac surgeons/interventional cardiologists [2].…”

Section: Baseline Clinical Characteristicsmentioning

confidence: 60%

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Complex and High-Risk Percutaneous Intervention Assisted By Extracorporeal Membrane Oxygenation (ECMO)

Ullah

Liu

2023

Preprint

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Background Cases where traditional PCI is insufficient to manage complex and high-risk lesions. In recent times, use of extracorporeal membrane oxygenation (ECMO) during PCI emerged as potential solution to manage complex and high-risk lesions. Methods Retrospective study patients elective high-risk PCI with hemodynamic support provided VA-ECMO (2018-2022). Complications related to VA-ECMO rates, Complications related to PCI, death, and major cardiovascular, cerebral events during hospital stay and 1-year follow-up were analyzed. Results This retrospective study included 81 patients Average age: 62.74 ±10.807 years underwent high-risk PCI assisted ECMO.VA-ECMO for an average of 21.0 hr. Intra-aortic Balloon Pump IABP support in 32.1% patients. Pre-and post-PCI SYNTAX scores 39.92 ± (6.4) and 6.04 ± (9.25) respectively. (P <0.001). Most patients had triple-vessel coronary disease. Interoperated complications Cardiac Tamponade (N=1, 1.2%), Acute Myocardial Infarction (N=6, 7.2%), Cardiogenic Shock (N=2, 2.4%), Cardiac Arrest (N=2, 2.4%), Aortic Dissection Type-A (N=1, 1.2%). Blood hemoglobin Pre- and Post-PCI 136.17 ± 21.479 g/L and 106.67 ± 19.103 g/L respectively P<0.001). eGFR pre- and post-PCI 67.22 ± 26.85 and 60.09 ± 27.78 respectively (p<0.002), Pre and Post PCI EF were 38.69 ± 13.65 and 43.55 ± 13.72 respectively (p<0.001), Clinical Outcomes, Survival at discharge Healthy was (N=65, 80.2%), Death (N=16,19.8%) No lower limb ischemia, No acute renal injury, no bacteremia during hospitalization. 1-year post-operation death (N=6, 7.2%) Conclusion In conclusion, ECMO-assisted high-risk PCI proves to be a safe and effective strategy for complex procedures in patients who are not candidates for Coronary artery bypass grafting.

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Section: Baseline Clinical Characteristicsmentioning

confidence: 60%

“…This study outcomes aligns with similar studies conducted at other single-center facilities. [17][18][19][20][21][22][23]…”

mentioning

confidence: 99%

Complex and High-Risk Percutaneous Intervention Assisted By Extracorporeal Membrane Oxygenation (ECMO)

Ullah

Liu

2023

Preprint

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“…During PCI, ECMO does not depend on the patient’s heart rhythm and function, so it can provide a stable blood circulation and sufficient oxygen to the body and ischemic/hypoxic tissues, as well as reducing acidosis, promoting metabolite removal, promoting the recovery of the autonomic circulation, and reducing functional damage to other organs [ 4 ]. ECMO may pave the way for rapid myocardial reperfusion therapy, thereby reducing the mortality of critically ill patients with AMI and cardiogenic shock.…”

Section: Discussionmentioning

confidence: 99%

Successful percutaneous coronary intervention with extracorporeal membrane oxygenation in a patient with acute inferior wall myocardial infarction complicated by electrical storm, cardiogenic shock, and cardiac arrest: a case report

Yan

Zhang

Huang

et al. 2023

J Cardiothorac Surg

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Background High-risk patients with coronary heart disease who develop acute myocardial infarction (AMI) have severe coronary lesions. If severe complications occur, such as malignant ventricular arrhythmia, cardiogenic shock, and cardiac arrest, implementation of emergency percutaneous coronary intervention (PCI) may be hindered, leading to a higher perioperative mortality rate. Extracorporeal membrane oxygenation (ECMO) can pave the way for rapid myocardial reperfusion therapy. When cardiac arrest occurs, hemodynamic support with ECMO can facilitate revascularization with PCI, which can increase the time available for further salvage and treatment and reduce intraoperative risk during PCI. Case presentation Herein, we report a case of a 61-year-old man with AMI who suffered electrical storm of sustained malignant ventricular fibrillation, cardiogenic shock, and cardiac arrest and was successfully treated with PCI with ECMO support. During PCI, repeated aspiration and removal of the right coronary artery thrombus were performed, and blood flow was restored after right coronary artery balloon dilation. One episode of defibrillation was delivered to restore sinus rhythm. Then, stents were implanted in the distal and proximal right coronary artery lesions to achieve revascularization. After PCI with ECMO support, irreversible malignant arrhythmia returned to sinus rhythm through coronary perfusion, which prevented death following unsuccessful cardiopulmonary resuscitation. After applying active treatments, including anti-shock, mechanical ventilation, anti-inflammation, and organ support, the patient was discharged after his condition and vital signs stabilized. The patient was followed up once a week after hospital discharge, and his cardiopulmonary function recovered well. Conclusions With ECMO support, PCI should be performed immediately in patients with inferior wall AMI complicated by electrical storm of sustained ventricular fibrillation, cardiogenic shock, and cardiac arrest to facilitate stent placement, achieve complete revascularization, restore coronary perfusion, and avoid death

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“…In one study [22], among 2108715 consecutive patients with stable coronary artery disease undergoing elective PCI, 6905 (0.3%) patients underwent elective PCI with prophylactic mechanical circulatory support (MCS). The published experience with the IABP-SHOCK II trial suggested that IABP, an older circulatory assist device, was ineffective in patients with circulatory failure [23]. However, in clinical application, IABP will affect the operation process of intraaortic surgery because the counterpulsation balloon is placed in the descending aorta.…”

Section: Discussionmentioning

confidence: 99%

Benefits of routine prophylactic extracorporeal membrane oxygenation for high-risk cardiac interventional surgery

Dong

Wang

et al. 2023

Preprint

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Background Complex high-risk percutaneous coronary intervention (PCI) and transcatheter aortic valve implantation (TAVI) are challenging and frequently associated with life-threatening complications. We evaluated the benefits of prophylactic extracorporeal membrane oxygenation (ECMO)-supported interventions and the risks of this approach. Methods From March 2020 to September 2021, 11 patients underwent TAVI, and 15 patients underwent PCI supported with prophylactic ECMO. Clinical characteristics and outcomes in terms of the requirement of ECMO were evaluated. Results Cannulation was femoro-femoral in all patients. TAVI was performed via transfemoral access. In the TAVI group, mean patient age was 72 ± 7.84 years and 63.64% were male. During valve implantation, supportive ECMO flow was maintained at 3.24 ± 0.19 L/min. The additional median time in the ICU was 2 (1–4) days. Patients were discharged from the hospital after 16 (15–27) days. All of them were successfully weaned off VA ECMO. Only 1 patient died of respiratory and cardiac arrest 10 days after the operation. During PCI, ECMO flow was maintained at 3.35 ± 0.22 L/min. The average age of the patients in this group was 59 ± 10.80 years, and the ejection fraction was 42.59 ± 16.34%. Fourteen patients were successfully weaned off VA ECMO and survived to hospital discharge. No ECMO-related, peripheral cannulation-related or life-threatening bleeding complications were observed in the two groups. The median follow-up was 6 months, and there was 1 late death. Conclusion Based on this experience, we consider ECMO support to be a viable alternative and effective approach for complex high-risk cardiac interventional surgery.

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Veno-Arterial Extracorporeal Membrane Oxygenation in Elective High-Risk Percutaneous Coronary Interventions

Cited by 14 publications

References 35 publications

Complex and High-Risk Percutaneous Intervention Assisted By Extracorporeal Membrane Oxygenation (ECMO)

Complex and High-Risk Percutaneous Intervention Assisted By Extracorporeal Membrane Oxygenation (ECMO)

Successful percutaneous coronary intervention with extracorporeal membrane oxygenation in a patient with acute inferior wall myocardial infarction complicated by electrical storm, cardiogenic shock, and cardiac arrest: a case report

Benefits of routine prophylactic extracorporeal membrane oxygenation for high-risk cardiac interventional surgery

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