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ECMO assisted angioplasty for cardiomyopathy patients with unstable angina
R A Ott1, T C Mills, J M Tobis
1Department of Cardiothoracic Surgery, University of California, Irvine Medical Center, Orange 92613.
Insights
Extracorporeal membrane oxygenation (ECMO)-assisted percutaneous coronary angioplasty (PTCA) offers a safe and effective treatment for patients with severe left ventricular dysfunction. This approach successfully palliates unstable angina in patients ineligible for traditional cardiac surgeries.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Patients with poor left ventricular function often present challenges for standard coronary revascularization.
- Unstable angina in this population requires alternative therapeutic strategies.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous coronary angioplasty (PTCA) performed during extracorporeal membrane oxygenation (ECMO) support.
- To assess this technique as a palliative option for patients unsuitable for conventional treatments.
Main Methods:
- Five patients with poor left ventricular function (mean EF 24%) underwent PTCA while supported by percutaneous femoral bypass (BARD CPS).
- Procedures included multi-vessel PTCA (3 patients) and aortic valve dilatation (1 patient).
- ECMO support duration ranged from 26 to 140 minutes.
Main Results:
- Successful PTCA was achieved in all patients.
- Mean ECMO duration was 104 minutes, with a mean transfusion requirement of 2 units of blood.
- Complications were limited to groin hematoma in two patients.
- All patients were discharged within 4 days and remained free of unstable angina at 4-7 month follow-up, maintaining NYHA Class II or III.
Conclusions:
- ECMO-assisted angioplasty is a viable and effective palliative treatment for unstable angina in patients with cardiomyopathy.
- This technique provides a crucial therapeutic option for high-risk patients ineligible for standard coronary bypass surgery or PTCA.
Abstract:
Patients who are otherwise unsuitable candidates for coronary bypass surgery or standard coronary angioplasty (PTCA) may be successfully treated with PTCA during ECMO. Five patients (3 men, 2 women), with a mean age of 57 years, are reported on here. They were not considered good candidates for standard therapy because of poor left ventricular function (mean EF, 24; range, 16 to 28%). Patients were supported by percutaneous femoral bypass using a BARD CPS machine, and underwent successful PTCA of either two vessels (three patients) or three vessels (two patients); in addition, one patient had dilatation of a stenotic aortic valve. Patients were supported with ECMO for 26 to 140 (mean 104) minutes, and required transfusion with 0 to 4 (mean 2) units of blood during or after the procedure. Complications included groin hematoma in two patients. All were discharged within 4 days of the procedure. Follow-up of the patients has been completed (4-7 mo) with no further hospitalizations for unstable angina. All patients remain in NYHA Class II or III. These data suggest that ECMO-assisted angioplasty is a safe and effective method of palliation of unstable angina associated with cardiomyopathy.