Role of Extracorporeal Membrane Oxygenation For Hemodynamic Support During Elective High Risk Percutaneous Coronary Interventions: Multi-Centeric Study
Tuesday, May 21, 2019
Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)
Naresh Sen DM, M.D.
,
Baba Yogi Netanath Hospital & Research Centre, Bhiwani, India
Jain Ashok, DM
,
Narayana Hrudayalaya, Jaipur, India
Rakesh Chittoda, M.D.
,
Fortis Hospital, Jaipur, India
Sonal Tanwar, Ph.D.
,
Baba Yogi Netanath Hospital & Research Centre, Bhiwani, India
Background:
In cases of cardiac insufficiency resulting in hemodynamic instability, several hemodynamic support devices can be used, including an intra-aortic balloon pump (IABP), the Tandem Heart device (Left Ventricle Assist Device -LVAD) , Impella and Extracorporeal membrane oxygenation (ECMO). Extracorporeal membrane oxygenation (ECMO) is most commonly used in patients with cardiac arrest and cardiogenic shock. We examined the in-hospital and mid-term clinical outcomes in patients undergoing complex, high-risk PCI with ECMO support.
Methods:
We conducted a retrospective multicentric analysis of ECMO-supported elective high-risk PCIs performed at three cardiac centre between Jan 2013 and Feb 2016 where Impella or LVAD was not registered. We assessed the in-hospital and mid-term major adverse cardiovascular event (MACE) rates, and reviewed bleeding and vascular complications after PCI and follow up months.
Results:
56 patients underwent elective high-risk PCI with ECMO support. Mean age was 57.6 ± 7.4 years and 75% were male (n=42). The mean left ventricular ejection fraction was 28.4 ± 12.6%. Most procedures were unprotected left main PCIs (n=28), Bifurcation lesion (n=16) and diffuse complex lesions(n=12). All PCIs were successful; 2 patient required coronary artery bypass surgical repair due to aortic dissection . The mean hospital stay post procedure was 5.8 ± 1.9 days. ECMO was successfully weaned in all cases, and the duration of ECMO was <24 hours in 8 cases. There was revasularization in 2 cases within 30 days and 1 year. Regarding major adverse cardiovascular event rate (MACE) was 2.6% as compare to IABP (8.7%).
Conclusions:
Major adverse cardiovascular event rate was less with support of ECMO as compare to IABP.ECMO can be successfully used for hemodynamic support during elective high-risk PCI. There are limited data on the use of ECMO for elective, high-risk percutaneous coronary intervention (PCI) , so further studies are required at mass level .
