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

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

JOURNAL=Frontiers in Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.913403

DOI=10.3389/fmed.2022.913403

ISSN=2296-858X

ABSTRACT=Background: This study determined the safety and feasibility of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as mechanical circulatory support during high-risk percutaneous coronary intervention (HR-PCI).
Methods: This retrospective study included patients with complex and high-risk coronary artery disease who underwent elective PCI with VA-ECMO support preoperatively during March 2019–December 2020. Rates of VA-ECMO-related complications, complications during PCI, death, myocardial infarction, and stroke during hospitalisation and 1-year postoperatively were analysed.
Results: Overall, 36 patients (average age: 63.6±8.9 years) underwent PCI. The average duration of VA-ECMO support was 12.5 (range, 3.0–26.3) h. Intra-aortic balloon pump counterpulsation was used in 44.4% of patients. The SYNTAX score was 34.6±8.4 preoperatively and 10.8±8.8 postoperatively (P<0.001). Intraoperative complications included pericardial tamponade (N=2, 5.6%), acute left-sided heart failure (N=1, 2.8%), malignant arrhythmia requiring electrocardioversion (N=2, 5.6%), and no deaths. Blood haemoglobin levels before PCI and 24 h after VA-ECMO withdrawal were 145.4±20.2 g/L and 105.7±21.7 g/L, respectively (P<0.001). Outcomes during hospitalisation included death (N=1, 2.8%), stroke (N=1, 2.8%), lower limb ischaemia (N=2, 5.6%), lower limb deep venous thrombosis (N=1, 2.8%), cannulation site haematoma (N=2, 5.6%), acute renal injury (N=2, 5.6%), bacteraemia (N=2, 5.6%), bleeding requiring blood transfusion (N=5, 13.9%), and no recurrent myocardial infarctions. Within 1 year postoperatively, two patients (5.6%) were hospitalised for heart failure.
Conclusions: VA-ECMO mechanical circulation support during HR-PCI is a safe and feasible strategy for achieving revascularisation in complex and high-risk coronary artery lesions. ECMO-related complications require special attention.