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

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.