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.

INTRODUCTION: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

[Percutaneous treatment of double valve defect with a modified extracorporeal membrane oxygenation system]. / Trattamento percutaneo di doppio vizio valvolare con sistema di ossigenazione extracorporea a membrana modificato.

Extracorporeal membrane oxygenation (ECMO) has been developed to provide hemodynamic support in patients with severe cardiac or respiratory failure. In the last few years, its use has become increasingly common in interventional cardiology rooms for high-risk coronary interventions and for transcatheter therapies for valvular disease, which are increasingly complex in subsets of fragile patients at high surgical risk and with multiple comorbidities.Here, we describe the treatment of an extremely critical patient for severe dual valvulopathy, severe impairment of post-infarct systolic function, advanced heart failure with prohibitive operative risk. In a single session, the double valvular volume defect was treated percutaneously, using ECMO with an additional drainage of the left ventricle, performing a transcatheter implantation of two aortic valve prostheses with the valve-in-valve technique and the implantation of two MitraClips with excellent final result.