Extracorporeal membrane oxygenation as perioperative right ventricular support in patients with biventricular failure undergoing left ventricular assist device implantation.
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 ± 4 mm) and RV systolic pressure (48 ± 14 mmHg). The mean pulmonary artery pressure (PAP) was 36 ± 9 mmHg. Nine patients showed dilatation of the tricuspid annulus (≥ 35 mm) 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%.


CONCLUSIONS
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.
Department of Thoracic and Cardiovascular Surgery, J.W. Goethe University, Frankfurt/Main, Germany. M.Scherer@em.uni-frankfurt.de
Mirela
M
Scherer
Abdul Sami
AS
Sirat
Anton
A
Moritz
Sven
S
Martens
D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000209:etiology; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D019106:Postoperative Hemorrhage / Q000209:etiology; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000628:therapy; D013203:Staphylococcal Infections / Q000209:etiology; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000517:prevention & control*