Benefits of prophylactic veno-arterial extracorporeal membrane oxygenation for high-risk cardiac interventions.

IF 1.6 3区 医学 Q2 SURGERY
Xiao-Chai Lv, Yi Dong, Lei Wang, Yan-Ting Hou, Liang-Wan Chen
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Abstract

Background: Complex high-risk percutaneous coronary intervention (PCI) and transcatheter aortic valve implantation (TAVI) are challenging and frequently associated with life-threatening complications. We evaluated the benefits of prophylactic extracorporeal membrane oxygenation (ECMO)-supported interventions and the risks of this approach.

Methods: From March 2020 to September 2021, 11 patients underwent TAVI, and 15 patients underwent PCI supported with prophylactic ECMO. Clinical characteristics and outcomes in terms of the requirement of ECMO were evaluated.

Results: Cannulation was femoro-femoral in all patients. TAVI was performed via transfemoral access. In the TAVI group, mean patient age was 72 ± 7.84 years and 63.64% were male. During valve implantation, supportive ECMO flow was maintained at 3.24 ± 0.19 L/min. The additional median time in the ICU was 2 (1-4) days. Patients were discharged from the hospital after 16 (15-27) days. All of them were successfully weaned off V-AECMO. Only 1 patient died of respiratory and cardiac arrest 10 days after the operation. During PCI, ECMO flow was maintained at 3.35 ± 0.22 L/min. The average age of the patients in this group was 59 ± 10.80 years, and the ejection fraction was 42.59 ± 16.34%. Fourteen patients were successfully weaned off veno-arterial ECMO and survived to hospital discharge. No ECMO-related, peripheral cannulation-related or life-threatening bleeding complications were observed in the two groups. The median follow-up was 6 months, and there was 1 late death.

Conclusion: Based on this experience, we consider ECMO support to be a viable alternative and effective approach for complex high-risk cardiac interventions.

背景:复杂的高风险经皮冠状动脉介入治疗(PCI)和经导管主动脉瓣植入术(TAVI)具有挑战性,经常会出现危及生命的并发症。我们评估了预防性体外膜肺氧合(ECMO)支持介入治疗的益处以及这种方法的风险:2020年3月至2021年9月,11名患者接受了TAVI,15名患者接受了预防性ECMO支持的PCI。方法:2020 年 3 月至 2021 年 9 月期间,11 名患者接受了 TAVI,15 名患者接受了 PCI,并辅以预防性 ECMO,评估了临床特征和需要 ECMO 的结果:所有患者的插管均为股股动脉。结果:所有患者的插管方式均为股股动脉,TAVI经股动脉入路。TAVI 组患者的平均年龄为 72 ± 7.84 岁,63.64% 为男性。在瓣膜植入过程中,支持性 ECMO 流量保持在 3.24 ± 0.19 升/分钟。在重症监护室的额外中位时间为 2(1-4)天。患者在住院 16(15-27)天后出院。所有患者都成功脱离了 V-AECMO。只有一名患者在术后 10 天死于呼吸和心跳骤停。PCI 期间,ECMO 流量保持在 3.35 ± 0.22 升/分钟。该组患者的平均年龄为(59±10.80)岁,射血分数为(42.59±16.34)%。14 名患者成功脱离静脉-动脉 ECMO,并存活至出院。两组患者均未出现与 ECMO 相关、与外周插管相关或危及生命的出血并发症。中位随访时间为 6 个月,有 1 例晚期死亡:基于此次经验,我们认为 ECMO 支持是复杂的高风险心脏介入手术的可行替代方案,也是一种有效的方法。
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来源期刊
BMC Surgery
BMC Surgery SURGERY-
CiteScore
2.90
自引率
5.30%
发文量
391
审稿时长
58 days
期刊介绍: BMC Surgery is an open access, peer-reviewed journal that considers articles on surgical research, training, and practice.
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