Successful Extracorporeal Membrane Oxygenation Assisted Revascularisation in A high-risk Elderly Patient Refused Surgical Treatment

Overview

Journal Acta Med Litu

Specialty General Medicine

Date 2020 May 2

PMID 32355458

Authors

Robertas Samalavicius

Lina Puodziukaite

Vytautas Abraitis

Ieva Norkiene

Nadezda Scupakova

Justina Pekarskiene

Aleksejus Zorinas

Kestutis Rucinskas

Pranas Serpytis

Affiliations

Soon will be listed here.

Abstract

Management of high-risk elderly patients requiring revascularisation remains a clinical challenge. We report a case of extracorporeal membrane oxygenation (ECMO) assisted complex percutaneous coronary intervention in a high-risk octogenarian. An 83-year-old female with signs of worsening heart failure was admitted to the emergency department of a tertiary care facility. Transthoracic echocardiography revealed a decreased left ventricular ejection fraction of 20% with severe mitral regurgitation and mild aortic and tricuspid valve insufficiency. Three-vessel disease was found during coronary angiography. Due to the patient's frailty, a high-risk surgery decision to proceed with ECMO assisted percutaneous coronary intervention was made during a heart team meeting. Following initiation of mechanical support, coronary lesions were treated with three drug-eluting stents. After the procedure, the patient was transferred to the ICU on ECMO support, where she was successfully weaned from the device 9 h later. Her ICU stay was four days. She was successfully discharged from the hospital after uneventful recovery. At one-year's follow-up, the patient was clinically stable in an overall state of general well-being and with complete participation in routine activities; she had good exercise tolerance and no signs of ischemia. This report highlights the possibility of use of ECMO during PCI in high-risk elderly patients.

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