Prophylactic ECMO Support during Elective Coronary Percutaneous Interventions in High-Risk Patients: A Single-Center Experience

IF 1.6 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of interventional cardiology Pub Date : 2023-02-04 DOI:10.1155/2023/5332038
Claudiu Ungureanu, Marc Blaimont, Hugues Trine, Pierre Henin, Romain Courcelle, Yves Laurent, Patrick Van Ruyssevelt, Caroline Lepièce, Vincent Huberlant
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Abstract

Introduction. Evidence regarding the impact of prophylactic implantation of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for elective high-risk percutaneous coronary intervention (PCI) is limited. The purpose of this paper is to evaluate the outcome during index hospitalization and 3 years after interventions. Methods. This is an observational retrospective study including all patients undergoing elective, high-risk PCI and receiving VA-ECMO for cardiopulmonary support. Primary endpoints were in-hospital and 3- year major adverse cardiovascular and cerebrovascular event (MACCE) rates. Secondary endpoints were vascular complications, bleeding, and procedural success. Results. Nine patients were included in total. All patients were considered inoperable by the local heart team, and 1 patient had a previous coronary artery bypass graft (CABG). All patients were hospitalized for an acute heart failure episode 30 days before the index procedure. Severe left ventricular dysfunction was present in 8 patients. The main target vessel was the left main coronary artery in 5 cases. Complex PCI techniques were used: bifurcations with 2 stents in 8 patients, rotational atherectomy was performed in 3, and coronary lithoplasty in 1 case. PCI was successful in all of the patients with revascularization of all target and additional lesions. Eight of the 9 patients survived for at least 30 days after the procedure, and 7 patients survived for 3 years after the procedure. Regarding the complication rate, 2 patients suffered from limb ischemia and were treated by an antegrade perfusion, 1 patient had a femoral perforation that needed surgical repair, 6 patients had a hematoma, 5 patients had a significant drop in hemoglobin of more than 2 g/dl and received blood transfusions, 2 patients were treated for septicemia, and 2 patients needed hemodialysis. Conclusions. Prophylactic use of VA-ECMO in elective patients is an acceptable strategy for revascularization by high-risk coronary percutaneous interventions with good long-term outcomes for patients considered inoperable when a clear clinical benefit is expected. Regarding the potential risk of complications due to a VA-ECMO system, the selection of candidates in our series was based on a multiparameter analysis. The two main triggers in favor of prophylactic VA-ECMO in our studies were the presence of a recent heart failure episode and the high probability of periprocedural prolonged impairment of the coronary flow through the major epicardial artery.

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高危患者在择期冠状动脉经皮介入治疗期间的预防性 ECMO 支持:单中心经验。
导言:有关为择期高风险经皮冠状动脉介入治疗(PCI)预防性植入静脉体外膜肺氧合(VA-ECMO)的影响的证据有限。本文旨在评估指数住院期间和介入治疗后 3 年的疗效:这是一项观察性回顾研究,包括所有接受择期高风险 PCI 并接受 VA-ECMO 心肺支持的患者。主要终点是院内和3年主要不良心脑血管事件(MACCE)发生率。次要终点是血管并发症、出血和手术成功率:共纳入九名患者。结果:共纳入九名患者,当地心脏团队认为所有患者均无法手术,其中一名患者曾接受过冠状动脉旁路移植术(CABG)。所有患者均在指数手术前 30 天因急性心衰住院。8 名患者存在严重的左心室功能障碍。5例患者的主要靶血管是左冠状动脉主干。使用了复杂的 PCI 技术:8 例患者使用了 2 个支架的分叉术,3 例患者进行了旋转粥样斑块切除术,1 例患者进行了冠状动脉碎石术。所有患者的 PCI 均获得成功,所有目标病变和其他病变均得到了血管再通。9 名患者中有 8 人在术后至少存活了 30 天,7 人在术后存活了 3 年。在并发症发生率方面,2名患者出现肢体缺血,接受了逆行灌注治疗,1名患者出现股骨头穿孔,需要手术修补,6名患者出现血肿,5名患者血红蛋白显著下降超过2 g/dl,接受了输血治疗,2名患者接受了败血症治疗,2名患者需要血液透析:结论:在择期手术患者中预防性使用 VA-ECMO 是一种可接受的策略,可用于高风险冠状动脉经皮介入的血管再通治疗,对于被认为无法手术的患者来说,在预期有明显临床获益的情况下,可获得良好的长期疗效。关于 VA-ECMO 系统引起并发症的潜在风险,我们是根据多参数分析来选择候选者的。在我们的研究中,支持预防性 VA-ECMO 的两个主要诱因是近期心衰发作和心外膜大动脉冠状动脉血流极有可能在围术期长期受损。
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来源期刊
Journal of interventional cardiology
Journal of interventional cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.80
自引率
0.00%
发文量
81
审稿时长
6-12 weeks
期刊介绍: Journal of Interventional Cardiology is a peer-reviewed, Open Access journal that provides a forum for cardiologists determined to stay current in the diagnosis, investigation, and management of patients with cardiovascular disease and its associated complications. The journal publishes original research articles, review articles, and clinical studies focusing on new procedures and techniques in all major subject areas in the field, including: Acute coronary syndrome Coronary disease Congenital heart diseases Myocardial infarction Peripheral arterial disease Valvular heart disease Cardiac hemodynamics and physiology Haemostasis and thrombosis
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