scholarly journals Venoarterial extracorporeal membrane oxygenation in elective high-risk percutaneous coronary intervention: a viable option?

2020 ◽  
Vol 28 (3) ◽  
pp. 136-138
Author(s):  
C. L. Meuwese ◽  
F. Z. Ramjankhan ◽  
A. O. Kraaijeveld ◽  
D. W. Donker
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Extracorporeal Membrane Oxygenation ◽  
Coronary Intervention ◽  
Viable Option ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Percutaneous Coronary

scholarly journals Successful extracorporeal membrane oxygenation assisted revascularisation in a high-risk elderly patient refused surgical treatment

2020 ◽  
Vol 26 (4) ◽  
pp. 205-210
Author(s):  
Robertas Samalavičius ◽  
Lina Puodžiukaitė ◽  
Vytautas Abraitis ◽  
Ieva Norkienė ◽  
Nadežda Ščupakova ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Elderly Patients ◽  
Extracorporeal Membrane Oxygenation ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Uneventful Recovery ◽  
Membrane Oxygenation ◽  
Percutaneous Coronary

Management of high-risk elderly patients requiring revascularisation remains a clinical challenge. We report a case of extracorporeal membrane oxygenation (ECMO) assisted complex percutaneous coronary intervention in a high-risk octogenarian. An 83-yearold female with signs of worsening heart failure was admitted to the emergency department of a tertiary care facility. Transthoracic echocardiography revealed a decreased left ventricular ejection fraction of 20% with severe mitral regurgitation and mild aortic and tricuspid valve insufficiency. Three-vessel disease was found during coronary angiography. Due to the patient’s frailty, a high-risk surgery decision to proceed with ECMO assisted percutaneous coronary intervention was made during a heart team meeting. Following initiation of mechanical support, coronary lesions were treated with three drug-eluting stents. After the procedure, the patient was transferred to the ICU on ECMO support, where she was successfully weaned from the device 9 h later. Her ICU stay was four days. She was successfully discharged from the hospital after uneventful recovery. At one-year’s follow-up, the patient was clinically stable in an overall state of general well-being and with complete participation in routine activities; she had good exercise tolerance and no signs of ischemia. This report highlights the possibility of use of ECMO during PCI in high-risk elderly patients.

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

2019 ◽  
Vol 28 (3) ◽  
pp. 139-144 ◽  
Author(s):  
F. S. van den Brink ◽  
T. A. Meijers ◽  
S. H. Hofma ◽  
A. J. van Boven ◽  
A. Nap ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
High Risk ◽  
Extracorporeal Membrane Oxygenation ◽  
Coronary Intervention ◽  
Membrane Oxygenation ◽  
Cardiopulmonary Support ◽  
Percutaneous Coronary ◽  
Main Target ◽  
Va Ecmo

Abstract 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.

scholarly journals Organoprotective Effects of Extracorporeal Membrane Oxygenation and Intra-Aortic Balloon Pump in High-Risk Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome

2020 ◽  
Vol 16 (1) ◽  
pp. 16-26
Author(s):  
R. A. Kornelyuk ◽  
D. L. Shukevich ◽  
I. E. Vereshchagin ◽  
V. I. Ganyukov
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Extracorporeal Membrane Oxygenation ◽  
Mechanical Circulatory Support ◽  
Coronary Intervention ◽  
Circulatory Support ◽  
Intra Aortic Balloon Pump ◽  
Coronary Syndrome ◽  
Membrane Oxygenation ◽  
Percutaneous Coronary

Purpose of the study: to evaluate the organoprotective effects of veno-arterial extracorporeal membrane oxygenation and intra-aortic balloon pump during high-risk percutaneous coronary intervention in acute coronary syndrome.Materials and methods. Patients required mechanical circulatory support (n=51) were divided into two study groups: patients who received mechanical circulatory support by veno-arterial extracorporeal membrane oxygenation (ECMO) (Group 1, n=29) during high-risk percutaneous coronary intervention, and Group 2 patients who received mechanical circulatory support by intra-aortic balloon pump (IABP) during high-risk percutaneous coronary intervention (Group 2, n=22). The dynamics of instrumental parameters and laboratory markers of organ damage were evaluated by electrocardiography, echocardiography, determining troponin I, creatine phosphokinases and creatinine levels, NGAL, venous blood saturation to compare the organoprotective properties of mechanical circulation support in the intra- and postoperative period.Results. The following values of the parameters were found the next day after the intervention: troponin I — 0.18 (0.1; 2.3) ng/ml in the ECMO group and 1.64 (0.92; 2.36) ng/ml in the IABP group (P=0.045); serum NGAL —139.4 (88.1; 166.7) ng/ml in the ECMO group and 212.3 (102; 279) in the IABP group (P=0.027); renal dysfunction (stages R, I, F according to RIFLE) — 2 (6.8%) observations in the ECMO group and 7 (31.8%) in the IABP group (P=0.021); multiple organ failure (2 or more points according to SOFA) — 3 (10.3%) cases in the ECMO group and 12 (54.5%) in the IABP group (P=0.001).Conclusion. Veno-arterial ECMO in comparison with IABP has a more pronounced organoprotective effect by achieving better hemodynamic stability, which, in turn, prevents hypoxia and the subsequent development of organ dysfunction. In addition, in conditions of veno-arterial ECMO, better completeness and quality of revascularization is ensured, and hospital mortality is also reduced.

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