Document Detail


Extracorporeal membrane oxygenation as perioperative right ventricular support in patients with biventricular failure undergoing left ventricular assist device implantation.
MedLine Citation:
PMID:  21071240     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Objective: Left-ventricular assist device (LVAD) implantation complicated by early right ventricle (RV) failure has a poor prognosis. This study details our center's experience with veno-arterial extracorporeal membrane oxygenation (ECMO) as perioperative RV support in patients with preoperative biventricular failure undergoing LVAD implantation. Methods: Ten patients, who underwent LVAD implantation, were retrospectively analyzed. Six patients were already supported with ECMO before LVAD implantation. In four patients, the ECMO was implanted before weaning from cardiopulmonary bypass. Results: All patients showed reduced RV function with elevated right-ventricular end-diastolic diameter (RVEDD) (38±4mm) and RV systolic pressure (48±14mmHg). The mean pulmonary artery pressure (PAP) was 36±9mmHg. Nine patients showed dilatation of the tricuspid annulus (≥35mm) with moderate tricuspid valve insufficiency and received tricuspid valve annuloplasty. After removal of the ECMO, none of the patients developed RV failure. ECMO was removed 4±1 days after LVAD implantation. Four patients expired while on LVAD support due to not-device-related sepsis (two patients), mesenteric ischemia (one patient), and gastrointestinal bleeding (one patient), respectively. Overall survival was 60%. Conclusion: ECMO provided a satisfactory perioperative right-heart support in patients with preoperative biventricular failure undergoing LVAD implantations, who otherwise were better candidates for biventricular assist device. ECMO allowed time for the already compromised right ventricle to get attuned to the increasing preload, and avoids distension and RV failure.
Authors:
Mirela Scherer; Abdul Sami Sirat; Anton Moritz; Sven Martens
Publication Detail:
Type:  Journal Article     Date:  2010-11-10
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  39     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-09     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  939-44     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Affiliation:
Department of Thoracic and Cardiovascular Surgery, J.W. Goethe University, Frankfurt/Main, Germany.
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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