IN-HOSPITAL AND LONG TERM RESULTS OF PERCUTANEOUS CORONARY INTERVENTION WITH BIVENTRICULAR SUPPORT AND EXTRACORPOREAL MEMBRANE OXYGENATION

Patients, due to various reasons not indicated for coronary bypass (CABG), usually have extremely high risk of complications in percutaneous intervention (PCI) as well. Recently it was shown that extracorporeal membrane oxygenation (ECMO) might provide a necessary support in the case of high risk PCI. ECMO can be effective in PCI in patients with refractory cardiogenic shock too, however evidence base for the technological approach in high risk PCI remains underdeveloped.

Aim. To evaluate in-hospital and long-term results of high risk PCI with biventricular bypass and ECMO in patients not fitted for CABG.

Material and methods. We conducted a retrospective analysis of the treatment of 12 patients having extremely high risk of complications in CABG. In all cases PCI was done in conditions of biventricular bypass and ECMO. Stable angina and non-STelevation acute coronary syndrome occurred in 42 and 58% cases, respectively. Clinical picture of cardiogenic shock was the criteria of exclusion. All patients had severe comorbidity with high score by “EuroScore” — 6,3±4,9%. In all cases there was multivessel disease with high level of coronary lesion involvement by “Syntax Score” (30,1±10,1). Mean level of left ventricle ejection fraction was satisfactory — 51±12,6%. Ten patients (83%) had significant (≥50 %) lesion of unprotected stem of the left coronary artery (SLCA).

Results. All procedures were successful. As a success of PCI we meant the opened artery with the flow rate not worse than TIMI 3 and absent of significant cardiovascular complications. Mean quantity of the implanted drug-eluting stents was 2,4±1. Full revascularization was reached in 42% cases. Residual value of “Syntax Score” was at the level about 6,33±6,88. Significant adverse cardiovascular complications (death, myocardial infarction, repeated non-planned revascularization) during inhospital phase were not registered. In one case there was an iliac artery dissection, that did not lead to necessity of surgery. Hemorrhagic complications were found just in one patients (8%, 2nd type by “BARC”). All patients were discharged. There were no any fatal cases or myocardial infarction (MI) in 6 months after observation. Two patients required another revascularization (17%). In long-term period there were no and signs of “definite” or “probable” stent thrombosis.

Conclusion. PCI in the conditions of biventricular bypass and ECMO might be effective alternative strategy of revascularization in a cohort of patients not indicated for CABG due to high complications risk.

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