Authors

• Boris Starčević — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-3090-2772
• Ante Lisičić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-4365-9652
• Mario Sičaja — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0003-0773-4720
• Mario Udovičić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-9912-2179
• Vanja Ivanović — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-6931-5404
• Ana Jordan — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-5610-6259
• Davor Barić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-5955-0275
• Daniel Unić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0003-2740-4067

Keywords

percutaneous coronary intervention, cardiogenic shock, acute heart failure, extracorporeal membrane oxygenation, ischemic heart disease

DOI

Full Text

Percutaneous mechanical circulatory support (MCS) has been used to stabilize patients in cardiogenic shock and provide hemodynamic support during high-risk percutaneous coronary interventions (PCI) for several decades. (1, 2) We report our recent experience with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) use in patients with HR-PCI and cardiogenic shock. Since 2014 thirteen patients (11 males, mean age 66.8 ± 11.5 years) have been referred to coronary angiography with ECMO support in our institution, 10 patients in cardiogenic shock and 3 as elective high risk (HR) PCI. The mean SYNTAX score was 24.1 ± 11.0. Eleven patients underwent a successful PCI, one patient was successfully bridged to emergency CABG and another to a high urgent heart transplant. Median time spent on ECMO was 24 hours. Six patients suffered in-hospital major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of death, acute myocardial infarction (MI), stroke, pulmonary embolism or further need for revascularization, all of them in the cardiogenic shock group. Up to October 2016 eight patients survive, all three from the elective HR-PCI group, who also did not suffer any MACCE, while in the cardiogenic shock group one-year survival rate was 50%. Although strong and convincing evidence is still lacking, VA-ECMO support represents a viable option for delivery of care and support in patients with HR-PCI and cardiogenic shock. In HR-PCI identification of critical patients and careful pre-procedural planning are paramount. In patients in cardiogenic shock, it is essential to initiate the support early enough. Introduction of VA ECMO as MCS in our catheterization laboratory for use in complex clinical situations has dramatically improved the survival of the most critical patients.

Literature

1. Atkinson TM, Ohman EM, O’Neill WW, Rab T, Cigarroa JE. Interventional Scientific Council of the American College of Cardiology. A Practical Approach to Mechanical Circulatory Support in Patients Undergoing Percutaneous Coronary Intervention: An Interventional Perspective. JACC Cardiovasc Interv. 2016;9(9):871–83. https://doi.org/10.1016/j.jcin.2016.02.046
2. Myat A, Patel N, Tehrani S, Banning AP, Redwood SR, Bhatt DL. Percutaneous circulatory assist devices for high-risk coronary intervention. JACC Cardiovasc Interv. 2015;8(2):229–44. https://doi.org/10.1016/j.jcin.2014.07.030