Venoarterial Extracorporeal Membrane Oxygenation (VA ECMO) Protected Percutaneous Coronary Intervention (PCI) in Multivessel Disease with Severe Mitral Regurgitation (MR) Ischaemic Cardiomyopathy
Abstract
Anand R Shenoy
Percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) are two methods for revascularizing complicated coronary artery disease, which includes multivessel coronary artery disease, left main stenosis, bifurcation stenosis, and chronic total occlusion (CTO). Patient features, the presence of comorbidities, such as diabetes, LV dysfunction, hemodynamic state, and coronary lesion complexity (by SYNTAX score), should all be considered when deciding whether to revascularize via CABG or PCI. High- risk PCI is being done more often in complicated coronary artery disease with a high risk of periprocedural cardiogenic shock because of higher surgical risk scores and comorbidities in ageing populations. For elective high-risk PCI, mechanical circulatory support (MCS) devices can offer hemodynamic support, averting hemodynamic failure. An intra-aortic balloon pump (IABP) and a coaxial left cardiac support device (Impella device (Abiomed, Danvers, USA)) have been used in a number of trials, however the results have not clearly demonstrated any advantages for IABP. Impella demonstrated certain benefits due to its greater hemodynamic support. An alternative to mechanical support alternatives for patients with possible or current circulation failure is venoarterial extracorporeal membrane oxygenation (VA-ECMO), which offers more comprehensive haemodynamic support. ECMO has the additional benefits of right ventricular unloading and blood oxygenation as compared to IABP and Impella. Therefore, herewith, we report a case of high-risk PCI which we performed under the protection of VA-ECMO.