Abstract
The impressive progresses of the last few decades have dramatically changed the management of cardiac conditions previously deemed “too high risk”. The use of extracorporeal membrane oxygenation (ECMO) as cardiopulmonary support has paved the way for new operative indications for those patients who were previously relegated to conservative medical management. The combination of a compact pump-oxygenator design, with smaller, percutaneous, flexible cannulae, makes the modern veno-arterial ECMO an ideal miniaturised cardiopulmonary bypass. In this chapter we will discuss the application of VA ECMO support during high-risk procedure such as percutaneous coronary interventions, transcatheter aortic valve implantation, post-infarct ventricular septal defect repair, and as bridge therapy before urgent pulmonary thromboembolectomy.
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Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators (2009) Extracorporeal membrane oxygenation for 2009 influenza A (H1N1) acute respiratory distress syndrome. JAMA 302(17):1888–1895
Spina R, Forrest AP, Adams MR, Wilson MK, Ng MK, Vallely MP (2010) Veno-arterial extracorporeal membrane oxygenation for high-risk cardiac catheterisation procedures. Heart Lung Circ 19(12):736–741
Vallely MP, Wilson MK, Adams M, Ng MKC (2012) How to set up a successful TAVI program. Ann Cardiothorac Surg 1(2):185–189
Ramponi F, Yan TD, Vallely MP, Wilson MK (2011) Total percutaneous cardiopulmonary bypass with Perclose ProGlide. Interact Cardiovasc Thorac Surg 13(1):86–88
Forrest P, Cheong JY, Vallely MP, Torzillo PJ, Hendel PN, Wilson MK, Bannontt PG, Bayfield MS, Herkes R, Walker SW (2011) International retrieval of adults on extracorporeal membrane oxygenation support. Anaesth Intensive Care 39(6):1082–1085
Ramponi F, Wilson MK, Vedelago J, Bayfield MS (2011) Catastrophic pulmonary and paradoxical embolism. ANZ J Surg 81(11):843–844
Vogel RA (1988) The Maryland experience: angioplasty and valvuloplasty using percutaneous cardiopulmonary support. Am J Cardiol 62(18):11K–14K
Taub JO, L’Hommedieu BD, Raithel SC, Vieth DG, Vieth PJ, Barner HB, Vandormael M, Pennington DG (1989) Extracorporeal membrane oxygenation for percutaneous coronary angioplasty in high risk patients. ASAIO Trans 35(3):664–666
Ott RA, Mills TC, Tobis JM, Allen BJ, Dwyer ML (1990) ECMO assisted angioplasty for cardiomyopathy patients with unstable angina. ASAIO Trans 36(3):M483–M485
Magovern GJ Jr, Simpson KA (1999) Extracorporeal membrane oxygenation for adult cardiac support: the Allegheny experience. Ann Thorac Surg 68(2):655–661
Silvestri M, Barragan P, Sainsous J, Bayet G, Simeoni JB, Roquebert PO, Macaluso G, Bouvier JL, Comet B (2000) Unprotected left main coronary artery stenting: immediate and medium-term outcomes of 140 elective procedures. J Am Coll Cardiol 35(6):1543–1550
Irons D, Lim YL, Lefkovits J, Esmore D (1996) Left main coronary artery stenting under extracorporeal circulatory support. Aust N Z J Med 26(6):842–843
Shammas NW, Roberts S, Early G (2002) Extracorporeal membrane oxygenation for unprotected left main stenting in a patient with totally occluded right coronary artery and severe left ventricular dysfunction. J Invasive Cardiol 14(12):756–759
Hasdai D, Topol EJ, Califf RM, Berger PB, Holmes DR Jr (2000) Cardiogenic shock complicating acute coronary syndromes. Lancet 356(9231):749–756
Zeymer U, Vogt A, Zahn R, Weber MA, Tebbe U, Gottwik M, Bonzel T, Senges J, Neuhaus KL (2004) Predictors of in-hospital mortality in 1333 patients with acute myocardial infarction complicated by cardiogenic shock treated with primary percutaneous coronary intervention (PCI); Results of the primary PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK). Eur Heart J 25(4):322–328
Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, Buller CE, Jacobs AK, Slater JN, Col J, McKinlay SM, LeJemtel TH (1999) Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med 341(9):625–634
Sarkar K, Kini AS (2010) Percutaneous left ventricular support devices. Cardiol Clin 28(1):169–184
Sjauw KD, Engström AE, Vis MM, van der Schaaf RJ, Baan J Jr, Koch KT, de Winter RJ, Piek JJ, Tijssen JG, Henriques JP (2009) A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines? Eur Heart J 30(4):459–468
Anderson H 3rd, Steimle C, Shapiro M, Delius R, Chapman R, Hirschl R, Bartlett R (1993) Extracorporeal life support for adult cardiorespiratory failure. Surgery 114(2):161–172
Chen JS, Ko WJ, Yu HY, Lai LP, Huang SC, Chi NH, Tsai CH, Wang SS, Lin FY, Chen YS (2006) Analysis of the outcome for patients experiencing myocardial infarction and cardiopulmonary resuscitation refractory to conventional therapies necessitating extracorporeal life support rescue. Crit Care Med 34(4):950–957
Arlt M, Philipp A, Voelkel S, Schopka S, Husser O, Hengstenberg C, Schmid C, Hilker M (2012) Early experiences with miniaturized extracorporeal life-support in the catheterization laboratory. Eur J Cardiothorac Surg 42(5):858–863
Lai CH, Chu YS, Li WL, Wang CC, Chang Y (2008) Percutaneous coronary intervention under extracorporeal membrane oxygenation support for high-risk acute myocardial infarction with cardiogenic shock. J Med Sci 28(1):39–44
Larsen AI, Hjørnevik A, Bonarjee V, Barvik S, Melberg T, Nilsen DW (2010) Coronary blood flow and perfusion pressure during coronary angiography in patients with ongoing mechanical chest compression: a report on 6 cases. Resuscitation 81(4):493–497
Wind J, Bekkers SC, van Hooren LJ, van Heurn LW (2009) Extensive injury after use of a mechanical cardiopulmonary resuscitation device. Am J Emerg Med 27(8):1017.e1–2
Lee MS, Pessegueiro A, Tobis J (2008) The role of extracorporeal membrane oxygenation in emergent percutaneous coronary intervention for myocardial infarction complicated by cardiogenic shock and cardiac arrest. J Invasive Cardiol 20(9):E269–E272
Tayara W, Starling RC, Yamani MH, Wazni O, Jubran F, Smedira N (2006) Improved survival after acute myocardial infarction complicated by cardiogenic shock with circulatory support and transplantation: comparing aggressive intervention with conservative treatment. J Heart Lung Transplant 25(5):504–509
Rodés-Cabau J, Webb JG, Cheung A, Ye J, Dumont E, Feindel CM, Osten M, Natarajan MK, Velianou JL, Martucci G, DeVarennes B, Chisholm R, Peterson MD, Lichtenstein SV, Nietlispach F, Doyle D, DeLarochellière R, Teoh K, Chu V, Dancea A, Lachapelle K, Cheema A, Latter D, Horlick E (2010) Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience. J Am Coll Cardiol 55(11):1080–1090
Husser O, Holzamer A, Philipp A, Nunez J, Bodi V, Müller T, Lubnow M, Luchner A, Lunz D, Riegger GA, Schmid C, Hengstenberg C, Hilker M (2013) Emergency and prophylactic use of miniaturized veno-arterial extracorporeal membrane oxygenation in transcatheter aortic valve implantation. Catheter Cardiovasc Interv 82(4):E542–E551
Jeppsson A, Liden H, Johnsson P, Hartford M, Rådegran K (2005) Surgical repair of post infarction ventricular septal defects: a national experience. Eur J Cardiothorac Surg 27(2):216–221
Fukushima S, Tesar PJ, Jalali H, Clarke AJ, Sharma H, Choudhary J, Bartlett H, Pohlner PG (2010) Determinants of in-hospital and long-term surgical outcomes after repair of postinfarction ventricular septal rupture. J Thorac Cardiovasc Surg 140(1):59–65
Thiele H, Kaulfersch C, Daehnert I, Schoenauer M, Eitel I, Borger M, Schuler G (2009) Immediate primary transcatheter closure of postinfarction ventricular septal defects. Eur Heart J 30(1):81–88
Crenshaw BS, Granger CB, Birnbaum Y, Pieper KS, Morris DC, Kleiman NS, Vahanian A, Califf RM, Topol EJ (2000) Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. GUSTO-I (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) Trial Investigators. Circulation 101(1):27–32
Menon V, Webb JG, Hillis LD, Sleeper LA, Abboud R, Dzavik V, Slater JN, Forman R, Monrad ES, Talley JD, Hochman JS (2000) Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: a report from the SHOCK Trial Registry. J Am Coll Cardiol 36:1110–1116
Tsai M, Wu H, Chan S, Luo C (2012) Extracorporeal membrane oxygenation as a bridge to definite surgery in recurrent postinfarction ventricular septal defect. ASAIO J 58:88–89
Rohn V, Spacek M, Belohlavek J, Tosovsky J (2009) Cardiogenic shock in patient with posterior postinfarction septal rupture – successful treatment with extracorporeal membrane oxygenation (ECMO) as a ventricular assist device. J Card Surg 24:435–436
Pitsis AA, Kelpis TG, Visouli AN, Bobotis G, Filippatos GS, Kremastinos DT (2008) Left ventricular assist device as a bridge to surgery in postinfarction ventricular septal defect. J Thorac Cardiovasc Surg 135:951–952
Alba AC, Rao V, Ivanov J, Ross HJ, Delgado DH (2009) Usefulness of the INTERMACS scale to predict outcomes after mechanical assist device implantation. J Heart Lung Transplant 28:827–833
Formica F, Avalli L, Colagrande L, Ferro O, Greco G, Maggioni E, Paolini G (2010) Extracorporeal membrane oxygenation to support adults with cardiac failure: predictive factors of 30 day mortality. Interact Cardiovasc Thorac Surg 10:721–726
Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, Bengel F, Brady AJ, Ferreira D, Janssens U, Klepetko W, Mayer E, Remy-Jardin M, Bassand JP, ESC Committee for Practice Guidelines (CPG) (2008) Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 29(18):2276–2315
Norita H, Ohteki H, Hisanou R (1994) Emergency pulmonary embolectomy for massive pulmonary embolism. J Jpn Coll Angiol 34:3–9
Rajdev S, Benza R, Misra V (2007) Use of Tandem Heart as a temporary hemodynamic support option for severe pulmonary artery hypertension complicated by cardiogenic shock. J Invasive Cardiol 19(8):E226–E229
Misawa Y, Fuse K, Yamaguchi T, Saito T, Konishi H (2000) Mechanical circulatory assist for pulmonary embolism. Perfusion 15(6):527–529
Deehring R, Kiss AB, Garrett A, Hillier AG (2006) Extracorporeal membrane oxygenation as a bridge to surgical embolectomy in acute fulminant pulmonary embolism. Am J Emerg Med 24(7):879–880
Howes J, Khilkin M, DeRose J, Dicpinigaitis P, Dulu A (2011) Veno-arterial extracorporeal membrane oxygenation as a salvage therapy in massive pulmonary embolism. Chest 140(4_MeetingAbstracts):64A. doi:10.1378/chest.1117995
Belohlavek J, Rohn V, Jansa P, Tosovsky J, Kunstyr J, Semrad M, Horak J, Lips M, Mlejnsky F, Balik M, Klein A, Linhart A, Lindner J (2010) Veno-arterial ECMO in severe acute right ventricular failure with pulmonary obstructive hemodynamic pattern. J Invasive Cardiol 22(8):365–369
Miyamoto S, Hadama T, Mori Y et al (1995) Hemodynamic profiles during concurrent intraaortic balloon pumping and venoarterial bypass — a canine study comparing subclavian and femoral artery perfusion sites. Jpn Circ J 59:693–703
Koster A, Weng Y, Böttcher W, Gromann T, Kuppe H, Hetzer R (2007) Successful use of bivalirudin as anticoagulant for ECMO in a patient with acute HIT. Ann Thorac Surg 83(5):1865–1867
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Ramponi, F., Forrest, P., Fraser, J.F., Musicki, K., Vallely, M.P. (2014). ECMO for High-Risk Procedures. In: Sangalli, F., Patroniti, N., Pesenti, A. (eds) ECMO-Extracorporeal Life Support in Adults. Springer, Milano. https://doi.org/10.1007/978-88-470-5427-1_13
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DOI: https://doi.org/10.1007/978-88-470-5427-1_13
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