Document Detail

Venovenous extracorporeal life support after pulmonary endarterectomy: indications, techniques, and outcomes.
MedLine Citation:
PMID:  17126125     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Pulmonary endarterectomy is the accepted therapy for thromboembolic pulmonary hypertension. A recognized complication of this surgery is the postoperative development of reperfusion edema, a potentially fatal cause of respiratory failure. Because reperfusion edema can be a reversible process, temporizing support measures may be life saving. METHODS: We retrospectively reviewed our experience with venovenous extracorporeal life support (V-V ECLS) from July 1990 to February 2006, in 20 adult patients (mean age 50.5 +/- 14.5 years) presenting with potentially reversible respiratory failure after pulmonary endarterectomy. This subset of patients comprised 1.12% of our total pulmonary endarterectomy experience during that time (1,790 cases). RESULTS: Overall in-hospital survival was 30.0% for patients requiring ECLS support after pulmonary endarterectomy versus 94.2% for patients who underwent pulmonary endarterectomy alone during the same timeframe. V-V ECLS was instituted at a mean of 86.8 hours after surgery. The mean duration of V-V ECLS was 123.4 +/- 71.3 hours. The most common cause of death in ECLS patients after pulmonary endarterectomy was pulmonary hemorrhage. Survival was greater in patients cannulated within 120 hours of surgery (46.2% survival; 6 of 13 patients) compared with those cannulated after 120 hours (0 of 7 patients). Multiple logistic regression identified long duration of mechanical ventilation pre-ECLS and severity of preoperative pulmonary hypertension together as predictors of mortality. CONCLUSIONS: A small subset of patients undergoing pulmonary endarterectomy develop temporary life-threatening respiratory failure secondary to severe reperfusion edema. In those patients with satisfactory hemodynamic outcome, V-V ECLS is a therapeutic option when all other conventional strategies have been exhausted.
Patricia A Thistlethwaite; Michael M Madani; Aaron D Kemp; Mary Hartley; William R Auger; Stuart W Jamieson
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  82     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2006-11-27     Completed Date:  2006-12-12     Revised Date:  2007-12-03    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  2139-45     Citation Subset:  AIM; IM    
Division of Cardiothoracic Surgery, University of California, San Diego, San Diego, California 92103-8892, USA.
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MeSH Terms
Endarterectomy / adverse effects*
Extracorporeal Circulation / methods*
Hypertension, Pulmonary / etiology,  surgery
Middle Aged
Pulmonary Artery / surgery*
Pulmonary Edema / etiology,  therapy*
Pulmonary Embolism / complications,  surgery*
Reperfusion Injury / etiology,  therapy
Retrospective Studies
Treatment Outcome
Grant Support
Comment In:
Ann Thorac Surg. 2006 Dec;82(6):2145-6   [PMID:  17126126 ]

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