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Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
Outcome of extracorporeal membrane oxygenation support for complex high-risk elective percutaneous coronary
Salvatore Davide Tomasello1, Marouane Boukhris2, Vladimir Ganyukov3
1Department of Medical Sciences and Pediatrics, Catheterization Laboratory and Cardiovascular Interventional Unit, Cannizzaro Hospital, University of Catania, Via Messina 829, 95126 Catania, Italy.
Insights
Extracorporeal membrane oxygenation (ECMO) provides safe hemodynamic support during high-risk percutaneous coronary intervention (PCI) for patients unsuitable for bypass surgery. This approach proves effective, with no in-hospital major adverse cardiac and cerebrovascular events observed.
Area of Science:
- Interventional Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Extracorporeal membrane oxygenation (ECMO) is established for hemodynamic support in cardiac arrest and shock.
- High-risk patients often face limited revascularization options due to surgical unsuitability.
Purpose of the Study:
- To evaluate the initial experience of using ECMO during elective high-risk percutaneous coronary intervention (PCI).
- To assess the safety and efficacy of ECMO-supported PCI in patients with complex coronary artery disease.
Main Methods:
- A single-center prospective study included patients at very high risk for coronary artery bypass grafting (CABG).
- Major adverse cardiac and cerebrovascular events (MACCE) were tracked, defined as death, myocardial infarction, stroke, or revascularization need.
Main Results:
- Twelve patients underwent elective high-risk PCI with ECMO support (mean age 63.5 years).
- All PCI procedures were successful with no in-hospital MACCE. At 6 months, no deaths or myocardial infarctions occurred.
- Two patients (17%) required further revascularization, and one needed chronic hemodialysis.
Conclusions:
- Elective high-risk PCI supported by ECMO is a feasible alternative for patients deemed too high-risk for CABG.
- ECMO provides crucial hemodynamic support, enabling complex PCI in a challenging patient population.
Objective:
We report our initial experience with extracorporeal membrane oxygenation (ECMO) use in elective high-risk complex percutaneous coronary intervention (PCI).
Background:
ECMO has been employed as hemodynamic support in patients with cardiac arrest and hemodynamic shock.
Methods:
We performed a single-center prospectical study, enrolling all patients at very high-risk for coronary artery bypass grafting (CABG). Major adverse cardiac and cerebrovascular events (MACCE) were defined as a composite of death, acute myocardial infarction (MI), stroke and further need for revascularization.
Results:
Twelve patients underwent elective high-risk PCI with ECMO support (mean age = 63.5 ± 8.7 years). The mean SYNTAX score was 30.1 ± 10.1. All PCI procedures were successful and no in-hospital MACCE was observed. At 6-months, neither death nor MI was noticed. Two patients (17%) required further revascularization, and one patient required chronic hemodialysis.
Conclusions:
Elective high-risk PCI supported by ECMO is a viable alternative for patients who are at very high risk for CABG.
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