Extracorporeal membrane oxygenation in emergency interventional cardiology as an alternative to conservative inoperable: a case from practice
AbstractECMO is currently not a routine practice in interventional cardiology. Meanwhile, the timely application of the method prevents the development of potential life-threatening complications.
The aim of this report was to present our own experience in using ECMO as a circulatory support in multivessel coronary lesions against the background of primary cardiomyopathy with a pronounced decrease in myocardial contractility, in emergency cardiac care.
Material and methods. A 76-year-old man was hospitalized for urgent cardiac indications with clinical presentation of acute coronary syndrome without ST-segment elevation on the background of coronary artery disease and previous AMI. Diagnosed with multi-vascular lesion of the coronary bed (trunk of the LCA, AntDesA and CircA), against the background of chronic heart failure, dilated cardiomyopathy, decline of LVEF up to 25% (Simpson) and severe concomitant pathology. The patient underwent: general anesthesia, transluminal balloon angioplasty with stenting of the trunk of the LCA, AntDesA and CircA by transradial access on the right and peripheral VA ECMO (a. femoralis sin., v. femoralis dex.). On a beating heart with ECMO flow up to 2 L/min/m2, which was about 80% of the actual CI 2.5 l/min/m2. The complexity of choosing the intervention tactics was due to the fact that at the previous stage of curation at the A.N. Bakulev NMIC CS, the traditional CABG operation was recognized as high-risk and was not recommended, but the patient’s condition at the time of admission to the SOGAZ-Gelendzhik IMC required interventional measures.
After the main stage of the operation, the emerging reperfusion syndrome with a decrease in LVEF to 20% (Simpson) required partial biventricular support by ECMO without the need for LV decompression (Echo-CG control) and the appointment of adrenergic support during next two hours, followed by stabilization of the state.
Results. The lumen of the arteries at the site of stent implantation was completely restored without signs of dissection and distal embolization. Perioperative use of ECMO made it possible to complete the operation in full and avoid life-threatening complications. When the patient was discharged from the hospital on the 6th day in a satisfactory condition, there was a clear positive dynamics and an improvement in the quality of life: no complaints, no chest pain, there is an increase in global heart contractility up to 31% (Simpson) and 37% in a year according by Echo-CG examination.
Keywords:ECMO; acute coronary syndrome, occlusion of the left coronary artery trunk, acute myocardial infarction; dilated cardiomyopathy
Funding. The study had no sponsor support.
Conflict of interest.The authors declare no conflict of interest.
For citation: Shelukhin D.A., Shiganov M.Yu., Markosyan A.V., Obrezan A.G., Teymurov T.Yu. ECMO in emergency interventional cardiology as an alternative to conservative inoperable: a case from practice. Kardiologiya: novosti, mneniya, obuchenie [Cardiology: News, Opinions, Training]. 2022; 10 (2): 45–50. DOI: https://doi.org/10.33029/2309-1908-2022-10-2-45-50 (in Russian)