The use of extracorporeal membrane oxygenation during myocardial revascularization in patients with coronary heart disease and cardiogenic shock
Keywords:extracorporeal membrane oxygenation, myocardial infarction, percutaneous transluminal coronary angioplasty, cardiogenic shock
Background. Extracorporeal membrane oxygenation has become an effective method in the treatment of adults and children with severe cardiac and pulmonary dysfunction resistant to conventional therapy. The aim of this article was to summarize an experience of extracorporeal membrane oxygenation usage for cardiac dysfunction, which develops in patients with coronary heart disease du-ring percutaneous transluminal coronary angioplasty. Materials and methods. The study comprised a retrospective, single-center analysis of 23 patients with coronary heart disease (19 men and 4 women, average age — 65.7 ± 12.3 years), who undertook the extracorporeal membrane oxygenation technique during percutaneous transluminal coronary angioplasty. Results. Thirteen (56.52 %) patients died directly in the hospital, or 30 days after a discharge. Independent predictors of fatal outcomes were: diabetes mellitus (OR = 17.58; 95% CI = 6.47–47.48; p = 0.00125), chronic renal failure (OR = 20.81; 95% CI = 5.95–72.21; p = 0.00014), damage to the right coronary artery (OR = 25.51; 95% CI = 8.27–79.12; p = 0.00013). For deceased patients, the “no-reflow” phenomenon was indicated in a larger portion of cases (23.1 % in the group of deceased versus 10 % in the group of survivors). A routine connection to extracorporeal membrane oxygenation before the occurrence of cardiac events was significantly more often used in the group of survived patients (90 % of cases) compared with the deceased (p = 0.0000001). Conclusions. Diabetes mellitus, chronic renal failure, and damage to the right co-ronary artery were independent predictors of mortality during percutaneous transluminal coronary angioplasty in patients with coronary heart disease. The routine use of extracorporeal membrane oxyge-nation in high-risk patients with percutaneous transluminal coronary angioplasty was a positive prognostic factor of patient survival.
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