Using ECMO during TAVI for exceptionally high risk patients

Within the spectrum of high-risk patients with aortic stenosis, some patients are of exceptional risk. They often have very weak hearts that predispose them to prohibitive risks of mortality when undergoing TAVI.

Our group has pioneered the use of Extracorporeal Membrane Oxygenation (ECMO), a new kind of heart support, to get these exceptionally high risk patients through the procedure.

Its use as a means of cardiac support in the adult population is not routine in clinical practice. In this paper, we review the indications, technical procedure, complications and outcomes of extracorporeal membrane oxygenation as pertinent to cardiac disease in general, and specifically, to catheter-based interventions.

We also describe two cases of high-risk cardiac catheterisation laboratory procedures performed with veno-arterial ECMO support in adult patients who were deemed to be at unacceptably high risk for conventional open-heart surgery and cardiopulmonary bypass.