title: Extracorporeal life support and left ventricular unloading in a non-intubated patient as bridge to heart transplantation.
abstract: BACKGROUND
  Veno-arterial extracorporeal life support (ECLS) is a well-established bridging therapy in patients with cardiac or pulmonary failure to maintain organ function and is frequently performed in patients who are not intubated. However, severly impaired cardiac function can occur pulmonary edemy in these patients, necessitating left ventricular unloading.
  
  
  RESULTS
  In this study we report a 37-year old female patient with familiar dilated cardiomyopathy suffering from acute biventricular heart failure. After implantation of a peripheral ECLS, the decreased ventricular led to refractory pulmonary edema. To unload the left ventricle, an percutaneous balloon atrioseptostomy was performed without intubating the patient. The left ventricle was vented by the venous cannula resting inside the atrioseptostomy. After twelve days on ECLS, the patient underwent orthotopic heart transplantation. The postoperative course was uneventful and the patient discharged from intensive care unit four days after surgery.
  
  
  CONCLUSIONS
  In this report we present a patient in which the hybrid technique of ECLS with secondary left ventricular unloading was successfully used as a bridge to transplant therapy. This procedure may offer an alternative bridge-to-decision options in selected patients, including those that were not intubated or anaesthetized.
authors.affiliation: Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilians-University, Munich - Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Peterss
authors.forename: Christian
authors.initials: C
authors.lastname: Pfeffer
authors.forename: Angela
authors.initials: A
authors.lastname: Reichelt
authors.forename: Frank
authors.initials: F
authors.lastname: Born
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Franz
authors.forename: Heinrich
authors.initials: H
authors.lastname: Netz
authors.forename: Ingo
authors.initials: I
authors.lastname: Kaczmarek
authors.forename: Christian
authors.initials: C
authors.lastname: Hagl
authors.forename: Nawid
authors.initials: N
authors.lastname: Khaladj
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000150:complications; D019299:Decompression, Surgical; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D011654:Pulmonary Edema / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016277:Ventricular Function, Left