Successful extracorporeal membrane oxygenation assisted revascularisation in a high-risk elderly patient refused surgical treatment
Intensive Care
Robertas Samalavičius
Lina Puodžiukaitė
Vytautas Abraitis
Ieva Norkienė
Nadežda Ščupakova
Justina Pekarskienė
Aleksejus Zorinas
Kęstutis Ručinskas
Pranas Šerpytis
Published 2020-04-14
https://doi.org/10.6001/actamedica.v26i4.4205
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Keywords

ECMO
percutaneous coronary intervention
coronary artery disease
elderly patient

How to Cite

Samalavičius R., Puodžiukaitė L., Abraitis V., Norkienė I., Ščupakova N., Pekarskienė J., Zorinas A., Ručinskas K. and Šerpytis P. (2020) “Successful extracorporeal membrane oxygenation assisted revascularisation in a high-risk elderly patient refused surgical treatment”, Acta medica Lituanica, 26(4), pp. 205-210. doi: 10.6001/actamedica.v26i4.4205.

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-yearold 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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