**6. Conclusion**

Our experience in the prophylactic use of ECMO in Cath-lab for the treatment of extremely complex patients has shown good results in both the short- and mediumterm. The success of this therapeutic strategy was confirmed by the medium-term results, considering that most of these patients, due to their age and basic clinical conditions, would have been destined for palliative medical therapy and a certain poor short-term prognosis [21–29].

*ECMO in Cath-Lab for Coronary, Structural or Combined Percutaneous Cardiac Interventional... DOI: http://dx.doi.org/10.5772/intechopen.105933*

**Figure 14.** *Outcome of ECMO percutaneous femoral access (A) and coronary angioplasty (B).*

**Figure 15.** *TAVI (A) and ECMO (B) percutaneous femoral access outcome.*

V-A ECMO was mainly used in the "bail-out" to address conditions of severe respiratory distress or refractory cardiogenic shock. Recently, however, its prophylactic use in the interventional cardiology laboratory has been considered, especially in complex and high-risk coronary procedures, showing good results and to a lesser extent for

structural interventional procedures (TAVI) with good results in terms of procedural "security."

Although there are no standardised criteria for defining a "high-risk" procedure, there is general consensus due to a variable combination of clinical and anatomical factors. Among the first are the presence of a compromised functional class (NYHA III/IV), ventricular dysfunction, pulmonary hypertension, haemodynamic or electrical instability, heart failure despite optimised therapy, and the presence of comorbidities. Among the latter include the extent and anatomy of coronary lesions, the extent of the ischemic area at risk during the procedure, the need to use "aggressive" devices (i.e. rotational atherectomy) and anatomical features of the valves. Furthermore, the clinical criticality of the patient may be due to the coexistence of coronary and valvular or plurivalvular disease requiring combined treatment causing an inexorable increase in procedural risk.

The presence of a multidisciplinary team expert in the treatment of complex diseases, which collaborates in the management of the entire length of hospitalisation of these patients is, therefore, fundamental. Starting from the correct choice of the procedure for each individual patient, to the planning of each step of the procedure itself and the intra- and post-procedural management with the active and productive comparison of each specialist.

Further studies are obviously needed to confirm the good results of the currently limited experiences, but we are confident that the use of ECMO to carry out this type of procedure represents an important therapeutic option in the near future.
