title: Extracorporeal membrane oxygenation as a novel bridging strategy for acute right heart failure in group 1 pulmonary arterial hypertension.
abstract: Patients with group 1 pulmonary arterial hypertension (PAH) and decompensated right heart failure (RHF) were not previously considered for extracorporeal membrane oxygenation (ECMO) as bridge to transplantation (BTT) or bridge to recovery (BTR) because options were limited by long transplantation wait times and perceived inability to wean ECMO. In a retrospective review, we describe our center's multidisciplinary mechanical-medical approach to ECMO as a bridging therapy for PAH (2009-2012). Suitability for ECMO was determined using a defined algorithm. Six patients (age, 32 ± 11 years) underwent mechanical-medical bridging. Two transplant-eligible patients underwent successful BTT. The four patients ineligible for transplantation underwent BTR with escalation of targeted medical therapies before weaning off ECMO. Three of four BTR patients survived to ECMO decannulation (duration, 12 ± 7; range, 7-23 days). In this single-institution experience, mechanical-medical BTT and BTR with ECMO and targeted PAH therapies were used as a novel treatment strategy to successfully manage acute RHF in PAH.
authors.affiliation: From the *Division of Pediatric Cardiology, Department of Pediatrics, Columbia University, College of Physicians and Surgeons, New York, New York; †Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York; and ‡Division of Cardiothoracic Surgery, Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, New York.
authors.forename: Erika B
authors.initials: EB
authors.lastname: Rosenzweig
authors.forename: Daniel
authors.initials: D
authors.lastname: Brodie
authors.forename: Darryl C
authors.initials: DC
authors.lastname: Abrams
authors.forename: Cara L
authors.initials: CL
authors.lastname: Agerstrand
authors.forename: Matthew
authors.initials: M
authors.lastname: Bacchetta
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000601:surgery*; D016040:Lung Transplantation; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult