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Aim: was to study in-hospital results of high-risk percutaneous coronary intervention (PCI) with extracorporeal circulatory support.

Material and methods: a single center, retrospective study was performed in 49 adult patients undergoing high-risk PCI with mechanical circulatory support (cardiopulmonary bypass - CPB and еxtracorporeal membrane oxygenation – ECMO) performed in high-risk patients with acute coronary syndrome, multiple coronary lesions and impaired ejection fraction between 2011 to 2019. Mean age was 64,4±6,7 years. Previous myocardial infarction had 38(77%) patients, 18(37%) patients had a history of previous cardiac surgery. In 18(37%) patients, ejection fraction (Simpson) was less than 30%. Mean value of the left main (LM) artery stenosis was 74,6±8,9%, while combined with occlusion or subocclusion right coronary artery (RCA) in 38(77%) patients. Multivessel coronary lesion had 42(86%) patients (average SYNTAX Score was 42,1±11,5 points)

Results: 17 patients (35%) underwent high-risk PCI under preventional mechanical circulatory support with CPB. Myocardial infarction, strokes, stent thrombosis, limb ischemia, lethal outcomes were not observed in these patients. 7(14%) patients were admitted to the Cath Lab with myocardial infarction complicated by cardiogenic shock, in 3 patients – with pulmonary edema. 12(24%) patients after previous heart surgery were admitted to the Cath Lab after cardiopulmonary resuscitation on extracorporeal circulatory support, four of them (8%) with ongoing chest compressions. In 6(12%) patients, during CAG/PCI, critical hemodynamic instability was observed, induced by incurable cardiac arrhythmias required an emergency extracorporeal support. Average time of extracorporeal circulatory support was 128,62±92,4 min. Complications associated with CPB and ECMO were not observed. Two patients (4%) had stroke in the postoperative period. Hospital mortality was 17(34,7%) patients.

Conclusion: extracorporeal circulatory supports provide good life maintenance for high-risk PCI and an possibility for emergency PCI in extreme clinical situations.




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