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- Title
Extracorporeal membrane oxygenation support for right ventricular failure after left ventricular assist device implantation.
- Authors
Riebandt, Julia; Haberl, Thomas; Wiedemann, Dominik; Moayedifar, R.; Mahr, Stéphane; Dimitrov, Kamen; Angleitner, Philipp; Laufer, Guenther; Zimpfer, Daniel; Schloeglhofer, Thomas
- Abstract
OBJECTIVES: Right ventricular (RV) failure complicating left ventricular assist device implantation is associated with increased mortality. Despite a lack of supporting evidence, venoarterial extracorporeal membrane oxygenation (ECMO) support is increasingly being used as an alternative to traditional temporary RV support. We report our institutional experience with ECMO-facilitated RV support after left ventricular assist device implantation. METHODS: We retrospectively reviewed the concept of temporary ECMO support for perioperative RV failure in 32 consecutive left ventricular assist device (mean age 52 ± 14 years; male 84.4%; ischaemic cardiomyopathy 40.6%; INTERMACS Level I 71.8%; INTERMACS Level II 6.3%; INTERMACS Level III 12.5%; INTERMACS Level IV-VII 9.4%; HeartWare ventricular assist device 75%; HeartMate II: 25%) from May 2009 to April 2014. The study end points were RV recovery during ECMO support, mortality and causes of death. RESULTS: Twenty-nine (90.6%) patients were successfully weaned from ECMO support after RV recovery. Three (9.4%) patients expired during ECMO support. ECMO support improved RV function and haemodynamic parameters (central venous pressure 13mmHg vs 10 mmHg, P < 0.01; mean pulmonary artery pressure 28mmHg vs 21 mmHg, P < 0.01; cardiac output 5.1 l/min vs 5.9 l/min, P = 0.09) over a median period of 3 (range 1-15) days. Thirty-day and in-hospital mortality were 18.8% and 25%, respectively. One-year survival was 75%, causes of death were multiorgan dysfunction syndrome (50%), sepsis (25%), haemorrhagic stroke (12.5%) and ischaemic stroke (12.5%). Causes of death during ECMO support were ischaemic stroke, sepsis and multiorgan dysfunction syndrome. CONCLUSIONS: Temporary ECMO-facilitated RV support is associated with good long-term outcomes and high rates of RV recovery.
- Subjects
EXTRACORPOREAL membrane oxygenation; LIFE support systems in critical care; RIGHT heart ventricle; HEART failure; TREATMENT effectiveness
- Publication
European Journal of Cardio-Thoracic Surgery, 2018, Vol 53, Issue 3, p590
- ISSN
1010-7940
- Publication type
Article
- DOI
10.1093/ejcts/ezx349