Successful extracorporeal membrane oxygenation support after pulmonary thromboendarterectomy.
BACKGROUND
Pulmonary thromboendarterectomy (PTE) is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension. However, some patients develop severe cardiorespiratory compromise soon after separating from cardiopulmonary bypass, either from early reperfusion pulmonary edema or right ventricular failure secondary to residual pulmonary hypertension. Since 2005 we have used venoarterial extracorporeal membrane oxygenation (ECMO) support in this group that has no other therapeutic option. We review our experience of early ECMO support in the severely compromised patient's post-PTE.


METHODS
We conducted a retrospective review of all patients undergoing PTE from a single national referral center between August 2005 and August 2007.


RESULTS
One hundred twenty-seven consecutive patients underwent PTE surgery. Seven patients (5.5%) had extreme cardiorespiratory compromise in the immediate postoperative period and required venoarterial ECMO support. Their mean age was 51.3 years with 3 males. When compared with patients not requiring ECMO, these patients had significantly poorer hemodynamic indices before the operation with mean pulmonary artery pressure of 62 mm Hg versus 51 mm Hg (p = 0.02) and pulmonary vascular resistance of 907 dynes/sec/cm(-5) versus 724 dynes/s(-1)/cm(-5) (p < 0.02). Mean duration of support was 119 hours (49 to 359 hours). Five patients were successfully weaned from ECMO support (73%) and 4 left the hospital alive, giving a salvage rate of 57%. For those who did not require ECMO support, hospital mortality was 4.2%.


CONCLUSIONS
Early venoarterial ECMO support has a role as rescue therapy post-PTE in patients with severe compromise who would probably otherwise die.
Berman
Marius
M
Department of Cardiothoracic Surgery, Papworth Hospital, Papworth Everard, Cambridge, United Kingdom.
Tsui
Steven
S
Vuylsteke
Alain
A
Snell
Andrew
A
Colah
Simon
S
Latimer
Ray
R
Hall
Roger
R
Arrowsmith
Joseph E
JE
Kneeshaw
John
J
Klein
Andrew A
AA
Jenkins
David P
DP
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002908:Chronic Disease; D015331:Cohort Studies; D004691:Endarterectomy / Q000379:methods* / Q000401:mortality*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011336:Probability; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome