Complex and High-Risk Percutaneous Intervention Assisted By Extracorporeal Membrane Oxygenation (ECMO)
Authors: Ullah Kifayat , Bin Liu 
Published: June 2023

Background

Despite improvements in PCI techniques and equipment, there are still cases where traditional PCI is insufficient to manage complex and high-risk lesions. Patients with these lesions have increased rates of major adverse cardiac events, including myocardial infarction, cardiogenic shock, and death. In recent years, the use of extracorporeal membrane oxygenation (ECMO) during PCI has emerged as a potential solution to managing complex and high-risk lesions.

Methods

This retrospective study included patients who underwent elective complex and high-risk percutaneous coronary interventions with hemodynamic support provided by Veno-Arterial external membrane oxygenation (VA-ECMO) from 2018 to 2022. Complications related to VA-ECMO rates, Complications related to PCI, death, and major cardiovascular, cerebral events (MACCE) during hospitalization and after one-year follow-up were analyzed.

Results

This retrospective study overall included 81 patients in which Males (N=60, 74.1%) and females (N=21, 25.9%) having (Average age: 62.74 ±10.807 years) underwent complex and high-risk percutaneous coronary intervention assisted ECMO. The VA-ECMO support was provided for an average of 21.0 hours (With a range of 1-312). Intra-aortic Balloon Pump IABP support was done in 32.1% of patients. The pre-and post-PCI SYNTAX scores of the patients were 39.92 ± (6.4) and 6.04 ± (9.25) respectively. (P <0.001). Most of the patients had triple vessel coronary disease which was the common coronary lesion (47%). Interoperated complications include Cardiac Tamponade (N=1,1.2%), Acute Myocardial Infarction (N=6,7.2%), Cardiogenic Shock (N=2,2.4%), Cardiac Arrest (N=2,2.4%), Arrhythmias malignant in nature which required electro cardioversion (2,2.4%), Ventricular tachycardia (N=1,1.2%), Non-infectious multiple organ failure MODS(N=1,1.2%), Aortic Dissection Type-A (N=1,1.2%). Blood hemoglobin Pre-CHIP assisted VA-ECMO PCI and Post-procedure were 136.17 ± 21.479 g/L and 106.67 ± 19.103 g/L respectively P<0.001). eGFR pre and post-PCI were 67.22 ± 26.85 and 60.09 ± 27.78 respectively (<0.002), Pre and Post PCI EF were 38.69 ± 13.65 and 43.55 ± 13.72 respectively (<0.001), During hospitalization the outcomes for the CHIP assisted by ECMO procedure include Death(N=16,19.8%), Inguinal Hematoma (N=2,2.5%), Bleeding from the punctured site (N=2,2.5%), Peudoaneurysm (N=1,1.2%), Cerebral Infarction(N=1,1.2%), Subarachnoid hemorrhage (N=1,1.2%), No lower limb ischemia, No acute renal injury, Bacteremia, were noted in any of the hospitalization. Patient Hb decline requiring blood transfusion therapy was (N=59, 72.8%). Survival at discharge (Healthy) was (N=65, 80.2%). After one year of post-operation death (N=6, 7.2%)

Conclusion

In conclusion, ECMO-assisted high-risk PCI proves to be a safe and effective strategy for complex procedures in patients who are not candidates for Coronary artery bypass grafting (CABG). The use of VA-ECMO resulted in minimal complications and low rates of MACCE during hospitalization and one-year follow-up. Further research is needed to determine the optimal timing for VA-ECMO initiation.