In-Hospital and Mid-Term Outcomes of ECMO Support During Coronary, Structural, or Combined Percutaneous Cardiac Intervention in High-Risk Patients – A Single-Center Experience

• Published in: Cardiovascular revascularization medicine 2021-11, Vol.32, p.63-67
• Main Authors: Brscic, Elvis, Rovero, Gabriella, Testa, Katiuscia, Sori, Pierpaolo, Iannaccone, Mario, Decio, Alessandro, Russo, Paolo, Costa, Paolo, Comoglio, Chiara, Marra, Sebastiano
• Format: Article
• Language: English
• Subjects: Complex intervention; ECMO; Invasive cardiac support; Mitraclip; TAVI
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2020.12.020

Evidence regarding the impact of prophylactic implantation of Extracorporeal Membrane Oxygenation (ECMO) during coronary or structural procedures is limited. The purpose of this paper is to evaluate the in-hospital and medium term outcomes of ECMO support in complex percutaneous coronary or structural intervention. The present is an observational prospective study including consecutive patients who underwent to prophylactic ECMO implantation for percutaneous coronary intervention (PCI), structural or combined interventions between July 2018 and July 2020 in Maria Pia Hospital GVM Care & Research, Turin, Italy. Primary endpoints were in-hospital and medium term all-cause death. Secondary endpoints were vascular complication, bleeding and procedural success. 27 patients were included with a mean age of 80 ± 6 years, 10 (37%) being diabetics and 19 (70%) with severe left ventricle dysfunction. Mean Logistic Euroscore was 28.7 ± 18.7. Seven patients (26%) underwent complex coronary revascularization, 7 (26%) combined PCI + TAVI, 5 (19%) combined PCI + Mitraclip, 5 (19%) TAVI alone and finally 3 (11%) combined TAVI + Mitraclip. The procedural success was 96%, with only one in-hospital death due to major vascular complication at the ECMO vascular access. At a mean follow-up of 11 ± 6.8 months 4 deaths were recorded (3 from not cardiovascular causes). Prophylactic use of ECMO may be beneficial for high risk patients undergoing complex combined coronary/structural percutaneous interventions with good in-hospital and mid-term outcomes in term of safety and procedural success. •Prophylactic ECMO support during complex cardiac interventions has been proposed in high risk patients, but outcomes have to be defined.•Our data shows that ECMO support during high risk TAVI combined with Mitral Clip or PCI is feasible with good procedural success and safety profile.•Prophylactic use of ECMO in this scenarios showed good mid-term outcomes.