Fu Wai Hospital Treats 85-Year-Old Patient with Complex Left Main Calcification Under ECMO Support

For critically ill patients aged 85, complicated by severe Chronic Obstructive Pulmonary Disease (COPD), critical lung function impairment, Acute Coronary Syndrome (ACS), and diffuse calcification spanning the Left Main Coronary Artery (LMCA) to the Left Anterior Descending Artery (LAD), conventional treatment is nearly impossible. Traditional surgical revascularization carries prohibitive risks, making this a true "no-go zone" for interventional cardiology. Recently, a multidisciplinary team (MDT) from Fu Wai Hospital—including Emergency, CCU, Pulmonary, and Extracorporeal Circulation departments—successfully performed Rotational Atherectomy (RA) + Drug-Coated Balloon (DCB) implantation under ECMO (Extracorporeal Membrane Oxygenation) life support, achieving a remarkable recovery.

The 85-year-old patient from Shangqiu was transferred to Fu Wai Hospital urgently due to severe angina exacerbated by minimal activity. Due to advanced age and complex comorbidities, local hospitals could not perform angiography or intervention. Initial MDT consultation confirmed ACS, NYHA Class III heart failure, pulmonary infection, and hypertension, further complicated by a history of prior MI treatment.

Angiography revealed diffuse calcification from the LMCA terminus to the LAD. LMCA atherectomy is one of the most technically challenging coronary interventions, as the "hard shell" of calcium prevents conventional device passage and risks catastrophic complications like rupture or dissection.

Core Technique and MDT Collaboration: To manage the patient's severely compromised pulmonary function and high surgical risk, the expert team designed a personalized "RA + DCB under ECMO Support" strategy:

1. Life Support: The ECMO Team initiated life support, temporarily assisting the patient's compromised cardiorespiratory function and ensuring hemodynamic stability during the complex procedure.
2. Interventional Breakthrough: Dr. Zheng Xiaohui, Director of Emergency Medicine, and his team used Rotational Atherectomy (RA), deploying a high-speed rotating burr to precisely "sculpt" and pulverize the diffuse calcified plaque. This procedure demands extreme precision and control to remove the calcium without damaging the vessel wall.
3. Targeted Therapy: Following successful atherectomy and ultrasound confirmation of no major complications, the experts applied Drug-Coated Balloon (DCB) technology. DCB was chosen to treat the lesion, avoiding the long-term risks and drawbacks associated with stent implantation in this complex, elderly patient.

Postoperative Systemic Management: After the cardiac intervention, the patient was transferred for specialized pulmonary care. Dr. Chen Xianliang’s Pulmonary team developed a precise anti-infection and comprehensive conditioning plan, carefully balancing the needs of the lung infection with the patient's cardiac status. Through seamless MDT coordination and meticulous care, the pulmonary infection was controlled, cardiac function improved, and the patient was discharged safely.

This successful intervention demonstrates Fu Wai Hospital's elite technical skill and extensive experience in interventional cardiology for elderly, high-risk patients with complex calcified lesions. More importantly, it highlights the powerful systemic advantage of MDT collaboration, establishing a robust defense line for the most critical cardiovascular patients.