AUTHOR=Bai Ming , Lu Andong , Pan Chenliang , Hu Sixiong , Qu Wenjing , Zhao Jing , Zhang Bo 

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

JOURNAL=Frontiers in Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.913403

DOI=10.3389/fmed.2022.913403

ISSN=2296-858X

ABSTRACT=<sec><title>Background</title><p>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.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Results</title><p>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 (<italic>P</italic> &lt; 0.001). Intraoperative complications included pericardial tamponade (<italic>N</italic> = 2, 5.6%), acute left-sided heart failure (<italic>N</italic> = 1, 2.8%), malignant arrhythmia requiring electrocardioversion (<italic>N</italic> = 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 (<italic>P</italic> &lt; 0.001). Outcomes during hospitalisation included death (<italic>N</italic> = 1, 2.8%), stroke (<italic>N</italic> = 1, 2.8%), lower limb ischaemia (<italic>N</italic> = 2, 5.6%), lower limb deep venous thrombosis (<italic>N</italic> = 1, 2.8%), cannulation site haematoma (<italic>N</italic> = 2, 5.6%), acute renal injury (<italic>N</italic> = 2, 5.6%), bacteraemia (<italic>N</italic> = 2, 5.6%), bleeding requiring blood transfusion (<italic>N</italic> = 5, 13.9%), and no recurrent myocardial infarctions. Within 1 year post-operatively, two patients (5.6%) were hospitalised for heart failure.</p></sec><sec><title>Conclusions</title><p>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.</p></sec>