VA-ECMO and IABP Supported CHIP-PCI for Left Main Bifurcation and CTO After Failed CABG

Patients with advanced coronary artery disease, prior coronary artery bypass grafting failure, and left ventricular dysfunction represent a particularly high-risk population, especially in last remaining vessel scenarios. Complex percutaneous coronary intervention (PCI) involving left main bifurcation disease, chronic total occlusions, and severe calcification carries substantial risk of hemodynamic collapse.

A 66-year-old man with prior coronary artery bypass grafting and ischemic cardiomyopathy presented with limiting angina and dyspnea. Coronary angiography demonstrated occluded left internal mammary artery graft, severely degenerated saphenous vein graft, chronic total occlusions of the circumflex and right coronary arteries, severe left main disease, and diffuse calcified disease of the left anterior descending artery. After heart team discussion, the patient was deemed inoperable. Complex high-risk indicated PCI was successfully performed under combined venoarterial extracorporeal membrane oxygenation and intra-aortic balloon pump support.

Prophylactic mechanical circulatory support may provide hemodynamic stability and facilitate safe, complete revascularization in extreme high-risk coronary interventions.

In inoperable patients with advanced coronary disease and ventricular dysfunction, mechanically supported complex high-risk indicated PCI may enable safe and effective complete revascularization.