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

Ming Bai; Andong Lu; Chenliang Pan; Sixiong Hu; Wenjing Qu; Jing Zhao; Bo Zhang

doi:10.3389/fmed.2022.913403

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

Front Med (Lausanne). 2022 May 26:9:913403. doi: 10.3389/fmed.2022.913403. eCollection 2022.

Authors

Ming Bai^{1

2

3

4}, Andong Lu^{1

2

3

4}, Chenliang Pan^{1

2

3

4}, Sixiong Hu^{1

2

3

4}, Wenjing Qu¹, Jing Zhao^{1

2

3

4}, Bo Zhang^{1

2

3

4}

Affiliations

¹ The First School of Clinical Medicine of Lanzhou University, Lanzhou, China.
² Heart Center, The First Hospital of Lanzhou University, Lanzhou, China.
³ Gansu Key Laboratory for Cardiovascular Diseases of Gansu Province, Lanzhou, China.
⁴ Cardiovascular Clinical Research Center of Gansu Province, Lanzhou, China.

Abstract

Background: The safety and feasibility of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as mechanical circulatory support in high-risk percutaneous coronary intervention (HR-PCI) remain unclear.

Methods: This retrospective study included patients with complex and high-risk coronary artery disease who underwent elective PCI with VA-ECMO support pre-operatively during March 2019-December 2020. Rates of VA-ECMO-related complications, complications during PCI, death, myocardial infarction, and stroke during hospitalisation and 1-year post-operatively 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 pre-operatively and 10.8 ± 8.8 post-operatively (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 post-operatively, two patients (5.6%) were hospitalised for heart failure.

Conclusions: Veno-arterial extracorporeal membrane oxygenation mechanical circulation support during HR-PCI is a safe and feasible strategy for achieving revascularisation in complex and high-risk coronary artery lesions. VA-ECMO-related complications require special attention.

Keywords: complications; elective high-risk percutaneous coronary interventions; outcomes; safe and feasible; veno-arterial extracorporeal membrane oxygenation.