Dong Yi, Xu Zheng, Dai Xiao-Fu, Chen Liang-Wan, Lin Zhi-Qin
Department of Cardiovascular Surgery, Fujian Heart Medical Center, Fujian Medical University Union Hospital, 350001 Fuzhou, Fujian, China.
Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, 350001 Fuzhou, Fujian, China.
Rev Cardiovasc Med. 2024 Sep 6;25(9):317. doi: 10.31083/j.rcm2509317. eCollection 2024 Sep.
Ischemic cardiomyopathy (ICM) is a common condition that leads to left ventricular (LV) functional remodeling and poor prognosis. Extracorporeal membrane oxygenation (ECMO) can provide temporary circulatory support and facilitate percutaneous coronary intervention (PCI) in patients with ICM and hemodynamic instability. However, the impact of ECMO-assisted PCI on LV functional remodeling and clinical outcomes in ICM patients is unclear.
We retrospectively analyzed 76 patients with ICM who underwent ECMO-assisted PCI at our institution between January 2013 and December 2022. We assessed the changes in LV functional remodeling using echocardiography at baseline and 12 months after the procedure. We also evaluated the incidence of major adverse cardiac and cerebrovascular events (MACCEs) and ECMO-related complications during hospitalization and at one-year follow-up.
The mean baseline left ventricular ejection fraction (LVEF) was 29.98 ± 2.65%. The rate of complete revascularization was 58%. The median duration of ECMO support was 38.99 hours. The most common ECMO-related complications were bleeding (8%) and lower extremity ischemia (5%). The one-year mortality rate was 30%. The overall freedom from MACCEs at 12 months was 59% (95% confidence interval (CI): 49-71%). LVEF increased significantly after the procedure from baseline to 6 months, yet decreased slightly at 12 months, although it was still higher than the baseline value. Wall motion score index (WMSI), end-diastolic volume index (EDVI), and end-systolic volume index (ESVI) decreased significantly from baseline to 12 months, indicating an improvement in LV function and a reduction in LV size.
In a high-volume tertiary center with extensive experience in advanced heart failure therapies and a dedicated ECMO team, ECMO-assisted PCI demonstrated feasibility and safety in patients with ischemic cardiomyopathy. However, the rate of complete revascularization was modest at 58%. Despite the high-risk profile of the patients, ECMO-assisted PCI was associated with a significant improvement in LV functional remodeling and a favorable 12-month survival rate. Further prospective studies are needed to confirm these findings and to identify the optimal patient and device selection criteria for ECMO-assisted PCI.
缺血性心肌病（ICM）是一种常见疾病，可导致左心室（LV）功能重塑及预后不良。体外膜肺氧合（ECMO）可为ICM合并血流动力学不稳定的患者提供临时循环支持，并便于进行经皮冠状动脉介入治疗（PCI）。然而，ECMO辅助PCI对ICM患者左心室功能重塑及临床结局的影响尚不清楚。
我们回顾性分析了2013年1月至2022年12月期间在我院接受ECMO辅助PCI的76例ICM患者。我们在基线及术后12个月时使用超声心动图评估左心室功能重塑的变化。我们还评估了住院期间及1年随访时主要不良心脑血管事件（MACCEs）的发生率以及与ECMO相关的并发症。
平均基线左心室射血分数（LVEF）为29.98±2.65%。完全血运重建率为58%。ECMO支持的中位持续时间为38.99小时。最常见的与ECMO相关的并发症是出血（8%）和下肢缺血（5%）。1年死亡率为30%。术后12个月时MACCEs的总体无事件生存率为59%（95%置信区间（CI）：49 - 71%）。术后从基线到6个月LVEF显著增加，但在12个月时略有下降，尽管仍高于基线值。室壁运动评分指数（WMSI）、舒张末期容积指数（EDVI）和收缩末期容积指数（ESVI）从基线到12个月显著下降，表明左心室功能改善且左心室大小减小。
在一家在晚期心力衰竭治疗方面经验丰富且拥有专业ECMO团队的大型三级中心，ECMO辅助PCI在缺血性心肌病患者中显示出可行性和安全性。然而，完全血运重建率为58%，处于中等水平。尽管患者风险较高，但ECMO辅助PCI与左心室功能重塑的显著改善及良好的12个月生存率相关。需要进一步的前瞻性研究来证实这些发现，并确定ECMO辅助PCI的最佳患者及设备选择标准。
