ECMO辅助下对LVEF明显降低冠心病患者CTO病变行PCI的疗效和安全性

Efficacy and safety of extracorporeal membrane oxygenation-supported percutaneous coronary intervention in chronic coronary total occlusion patients with reduced left ventricular ejection fraction

目的初步探讨体外膜肺氧合(ECMO)辅助下对左心室射血分数(LVEF)明显降低的冠状动脉慢性完全闭塞(CTO)病变患者行经皮冠状动脉介入治疗(PCI)的疗效及安全性。方法回顾性分析2018年12月至2022年3月于北部战区总医院在ECMO辅助下接受PCI的术前LVEF≤35%的CTO病变患者的临床资料。观察患者术后并发症及LVEF变化情况,出院后随访全因死亡发生情况和LVEF的变化。结果共入选17例患者,年龄(59.4±11.8)岁,其中男性14例。PCI前超声心动图测得患者的LVEF为(29.00±4.08)%。冠状动脉造影结果显示,17例患者共存在29处CTO病变,其中左主干CTO病变1例,前降支CTO病变7例,回旋支CTO病变11例,右冠状动脉CTO病变10例。全部患者PCI术前成功预置ECMO,对25处CTO病变进行了介入治疗,其中24处成功开通并置入支架。每例患者至少开通1处CTO病变,置入(4.6±1.3)枚支架。术后,8例患者的血红蛋白下降>20 g/L,1例发生了ECMO术区动脉穿刺部位出血。患者术后2.5(2.0,5.5)d复查超声心动图,LVEF为(38.73±7.01)%,显著高于术前水平(P<0.001)。无院内死亡发生。出院后随访360(120,394)d,随访期间死亡3例(3/17)。出院后155(100,308)d复查超声心动图,LVEF值提升至(41.80±7.32)%,显著高于术前水平(P<0.001)。结论初步证明ECMO辅助下对低LVEF值冠心病患者CTO病变行PCI有较好的安全性、有效性和可行性。

ObjectiveTo investigate the feasibility and safety of extracorporeal membrane oxygenation(ECMO)-supported percutaneous coronary intervention(PCI)in chronic coronary total occlusion(CTO)patients with reduced left ventricular ejection fraction(LVEF).MethodsThe CTO patients with LVEF≤35%and undergoing CTO-PCI assisted by ECMO in the General Hospital of Northern Theater Command from December 2018 to March 2022 were enrolled in this study.The post-procedure complications,changes of LVEF from pre-procedure to post-procedure during hospitalization,and the incidence of all-cause mortality and changes of LVEF after discharge were assessed.ResultsA total of 17 patients aged(59.4±11.8)years were included.There were 14 males.The pre-procedure LVEF of these patients were(29.00±4.08)%.Coronary angiography results showed that there were 29 CTO lesions in these 17 patients.There was 1 in left main coronary artery,7 in left anterior descending artery,11 in left circumflex artery,and 10 in right coronary artery.ECMO was implanted in all patients before procedure.Among 25 CTO lesions attempted to cross,24 CTO were successfully implanted with stents.All patients underwent successful PCI for at least one CTO lesion.The number of drug-eluting stents implantation per patient were 4.6±1.3.After procedure,there were 8 patients with hemoglobin decreased>20 g/L,and 1 patient with ECMO-access-site related bleeding.The LVEF value at a median duration of 2.5(2.0-5.5)days after procedure significantly increased to(38.73±7.01)%(P<0.001 vs.baseline).There were no in-hospital deaths.Patients were followed up for 360(120,394)days after discharge,3 patients died(3/17).The LVEF value was(41.80±7.32)%at 155(100,308)days after discharge,which was significantly higher than the baseline value(P<0.001).ConclusionThe results of present study demonstrate that it is feasible,efficient and safe to perform ECMO-supported CTO-PCI in CTO patients with reduced LVEF.