Samalavičius Robertas, Puodžiukaitė Lina, Abraitis Vytautas, Norkienė Ieva, Ščupakova Nadežda, Pekarskienė Justina, Zorinas Aleksejus, Ručinskas Kęstutis, Šerpytis Pranas
2nd Department of Anaesthesiology, Centre of Anaesthesiology, Intensive Care and Pain Management, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
Clinic of Anaesthesiology and Intensive Care, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Acta Med Litu. 2019;26(4):205-210. doi: 10.6001/actamedica.v26i4.4205.
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-year-old 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.
对需要血运重建的高危老年患者进行管理仍然是一项临床挑战。我们报告了一例在体外膜肺氧合（ECMO）辅助下对一名高危八旬老人进行复杂经皮冠状动脉介入治疗的病例。一名83岁女性，出现心力衰竭加重迹象，被收入一家三级医疗机构的急诊科。经胸超声心动图显示左心室射血分数降至20%，伴有严重二尖瓣反流以及轻度主动脉瓣和三尖瓣关闭不全。冠状动脉造影发现三支血管病变。由于患者身体虚弱，在心脏团队会议上做出了进行ECMO辅助经皮冠状动脉介入治疗这一高危手术的决定。在启动机械支持后，使用三个药物洗脱支架对冠状动脉病变进行了治疗。术后，患者在ECMO支持下被转入重症监护病房（ICU），9小时后成功撤机。她在ICU住院四天。康复过程顺利后，她成功出院。在一年的随访中，患者临床状况稳定，整体状态良好，能够完全参与日常活动；她有良好的运动耐量，没有缺血迹象。本报告强调了在高危老年患者的经皮冠状动脉介入治疗（PCI）期间使用ECMO的可能性。
