Prophylactic ECMO Support during Elective Coronary Percutaneous Interventions in High-Risk Patients: A Single-Center Experience
Introduction. Evidence regarding the impact of prophylactic implantation of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for elective high-risk percutaneous coronary intervention (PCI) is limited. The purpose of this paper is to evaluate the outcome during index hospitalization and 3 y...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-01-01
|
| Series: | Journal of Interventional Cardiology |
| Online Access: | http://dx.doi.org/10.1155/2023/5332038 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832559510112174080 |
|---|---|
| author | Claudiu Ungureanu Marc Blaimont Hugues Trine Pierre Henin Romain Courcelle Yves Laurent Patrick Van Ruyssevelt Caroline Lepièce Vincent Huberlant |
| author_facet | Claudiu Ungureanu Marc Blaimont Hugues Trine Pierre Henin Romain Courcelle Yves Laurent Patrick Van Ruyssevelt Caroline Lepièce Vincent Huberlant |
| author_sort | Claudiu Ungureanu |
| collection | DOAJ |
| description | Introduction. Evidence regarding the impact of prophylactic implantation of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for elective high-risk percutaneous coronary intervention (PCI) is limited. The purpose of this paper is to evaluate the outcome during index hospitalization and 3 years after interventions. Methods. This is an observational retrospective study including all patients undergoing elective, high-risk PCI and receiving VA-ECMO for cardiopulmonary support. Primary endpoints were in-hospital and 3- year major adverse cardiovascular and cerebrovascular event (MACCE) rates. Secondary endpoints were vascular complications, bleeding, and procedural success. Results. Nine patients were included in total. All patients were considered inoperable by the local heart team, and 1 patient had a previous coronary artery bypass graft (CABG). All patients were hospitalized for an acute heart failure episode 30 days before the index procedure. Severe left ventricular dysfunction was present in 8 patients. The main target vessel was the left main coronary artery in 5 cases. Complex PCI techniques were used: bifurcations with 2 stents in 8 patients, rotational atherectomy was performed in 3, and coronary lithoplasty in 1 case. PCI was successful in all of the patients with revascularization of all target and additional lesions. Eight of the 9 patients survived for at least 30 days after the procedure, and 7 patients survived for 3 years after the procedure. Regarding the complication rate, 2 patients suffered from limb ischemia and were treated by an antegrade perfusion, 1 patient had a femoral perforation that needed surgical repair, 6 patients had a hematoma, 5 patients had a significant drop in hemoglobin of more than 2 g/dl and received blood transfusions, 2 patients were treated for septicemia, and 2 patients needed hemodialysis. Conclusions. Prophylactic use of VA-ECMO in elective patients is an acceptable strategy for revascularization by high-risk coronary percutaneous interventions with good long-term outcomes for patients considered inoperable when a clear clinical benefit is expected. Regarding the potential risk of complications due to a VA-ECMO system, the selection of candidates in our series was based on a multiparameter analysis. The two main triggers in favor of prophylactic VA-ECMO in our studies were the presence of a recent heart failure episode and the high probability of periprocedural prolonged impairment of the coronary flow through the major epicardial artery. |
| format | Article |
| id | doaj-art-be1fbc95d48e497997f67fc8af1c423a |
| institution | Kabale University |
| issn | 1540-8183 |
| language | English |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Interventional Cardiology |
| spelling | doaj-art-be1fbc95d48e497997f67fc8af1c423a2025-02-03T01:29:52ZengWileyJournal of Interventional Cardiology1540-81832023-01-01202310.1155/2023/5332038Prophylactic ECMO Support during Elective Coronary Percutaneous Interventions in High-Risk Patients: A Single-Center ExperienceClaudiu Ungureanu0Marc Blaimont1Hugues Trine2Pierre Henin3Romain Courcelle4Yves Laurent5Patrick Van Ruyssevelt6Caroline Lepièce7Vincent Huberlant8Cardiovascular DepartmentCardiovascular DepartmentIntensive Care DepartmentIntensive Care DepartmentIntensive Care DepartmentIntensive Care DepartmentCardiothoracic Surgery DepartmentCardiovascular DepartmentIntensive Care DepartmentIntroduction. Evidence regarding the impact of prophylactic implantation of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for elective high-risk percutaneous coronary intervention (PCI) is limited. The purpose of this paper is to evaluate the outcome during index hospitalization and 3 years after interventions. Methods. This is an observational retrospective study including all patients undergoing elective, high-risk PCI and receiving VA-ECMO for cardiopulmonary support. Primary endpoints were in-hospital and 3- year major adverse cardiovascular and cerebrovascular event (MACCE) rates. Secondary endpoints were vascular complications, bleeding, and procedural success. Results. Nine patients were included in total. All patients were considered inoperable by the local heart team, and 1 patient had a previous coronary artery bypass graft (CABG). All patients were hospitalized for an acute heart failure episode 30 days before the index procedure. Severe left ventricular dysfunction was present in 8 patients. The main target vessel was the left main coronary artery in 5 cases. Complex PCI techniques were used: bifurcations with 2 stents in 8 patients, rotational atherectomy was performed in 3, and coronary lithoplasty in 1 case. PCI was successful in all of the patients with revascularization of all target and additional lesions. Eight of the 9 patients survived for at least 30 days after the procedure, and 7 patients survived for 3 years after the procedure. Regarding the complication rate, 2 patients suffered from limb ischemia and were treated by an antegrade perfusion, 1 patient had a femoral perforation that needed surgical repair, 6 patients had a hematoma, 5 patients had a significant drop in hemoglobin of more than 2 g/dl and received blood transfusions, 2 patients were treated for septicemia, and 2 patients needed hemodialysis. Conclusions. Prophylactic use of VA-ECMO in elective patients is an acceptable strategy for revascularization by high-risk coronary percutaneous interventions with good long-term outcomes for patients considered inoperable when a clear clinical benefit is expected. Regarding the potential risk of complications due to a VA-ECMO system, the selection of candidates in our series was based on a multiparameter analysis. The two main triggers in favor of prophylactic VA-ECMO in our studies were the presence of a recent heart failure episode and the high probability of periprocedural prolonged impairment of the coronary flow through the major epicardial artery.http://dx.doi.org/10.1155/2023/5332038 |
| spellingShingle | Claudiu Ungureanu Marc Blaimont Hugues Trine Pierre Henin Romain Courcelle Yves Laurent Patrick Van Ruyssevelt Caroline Lepièce Vincent Huberlant Prophylactic ECMO Support during Elective Coronary Percutaneous Interventions in High-Risk Patients: A Single-Center Experience Journal of Interventional Cardiology |
| title | Prophylactic ECMO Support during Elective Coronary Percutaneous Interventions in High-Risk Patients: A Single-Center Experience |
| title_full | Prophylactic ECMO Support during Elective Coronary Percutaneous Interventions in High-Risk Patients: A Single-Center Experience |
| title_fullStr | Prophylactic ECMO Support during Elective Coronary Percutaneous Interventions in High-Risk Patients: A Single-Center Experience |
| title_full_unstemmed | Prophylactic ECMO Support during Elective Coronary Percutaneous Interventions in High-Risk Patients: A Single-Center Experience |
| title_short | Prophylactic ECMO Support during Elective Coronary Percutaneous Interventions in High-Risk Patients: A Single-Center Experience |
| title_sort | prophylactic ecmo support during elective coronary percutaneous interventions in high risk patients a single center experience |
| url | http://dx.doi.org/10.1155/2023/5332038 |
| work_keys_str_mv | AT claudiuungureanu prophylacticecmosupportduringelectivecoronarypercutaneousinterventionsinhighriskpatientsasinglecenterexperience AT marcblaimont prophylacticecmosupportduringelectivecoronarypercutaneousinterventionsinhighriskpatientsasinglecenterexperience AT huguestrine prophylacticecmosupportduringelectivecoronarypercutaneousinterventionsinhighriskpatientsasinglecenterexperience AT pierrehenin prophylacticecmosupportduringelectivecoronarypercutaneousinterventionsinhighriskpatientsasinglecenterexperience AT romaincourcelle prophylacticecmosupportduringelectivecoronarypercutaneousinterventionsinhighriskpatientsasinglecenterexperience AT yveslaurent prophylacticecmosupportduringelectivecoronarypercutaneousinterventionsinhighriskpatientsasinglecenterexperience AT patrickvanruyssevelt prophylacticecmosupportduringelectivecoronarypercutaneousinterventionsinhighriskpatientsasinglecenterexperience AT carolinelepiece prophylacticecmosupportduringelectivecoronarypercutaneousinterventionsinhighriskpatientsasinglecenterexperience AT vincenthuberlant prophylacticecmosupportduringelectivecoronarypercutaneousinterventionsinhighriskpatientsasinglecenterexperience |