title: Veno-venous extracorporeal membrane oxygenation using a double-lumen bi-caval cannula for severe respiratory failure post total artificial heart implantation.
abstract: We report a unique utilization of a double-lumen, bi-caval Avalon cannula for veno-venous (VV) extracorporeal membrane oxygenation (ECMO) during placement of a total artificial heart (TAH, SynCardia, Tucson, AZ). A 22-year-old female with post-partum cardiomyopathy was rescued on veno-arterial (VA) ECMO because of cardiogenic shock. The inability to wean ECMO necessitated implantation of the TAH as a bridge to transplant. In addition, the patient continued to have respiratory failure and concomitant VV ECMO was planned with the implant. During TAH implantation, the Avalon cannula was placed percutaneously from the right internal jugular vein into the inferior vena cava (IVC) under direct vision while the right atrium was open. During VV ECMO support, adequate flows on both ECMO and TAH were maintained without adverse events. VV ECMO was discontinued, without reopening the chest, once the patient's respiratory failure improved. However, the patient subsequently developed a profound respiratory acidosis and required VV ECMO for CO2 removal. The Avalon cannula was placed in the femoral vein to avoid accessing the internal jugular vein and risking damage to the TAH. The patient's oxygenation eventually improved and the cannula was removed at the bedside. The patient was supported for 22 days on VV ECMO and successfully weaned from the ventilator prior to her orthotropic heart transplantation.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Miessau
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Q
authors.initials: Q
authors.lastname: Yang
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Unai
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: J W C
authors.initials: JW
authors.lastname: Entwistle
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: N C
authors.initials: NC
authors.lastname: Cavarocchi
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA Hitoshi.Hirose@jefferson.edu.
authors.forename: H
authors.initials: H
authors.lastname: Hirose
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006354:Heart, Artificial; D006801:Humans; D011183:Postoperative Complications / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D019919:Prosthesis Implantation / Q000009:adverse effects*; D011859:Radiography; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*
keywords: ECMO; respiratory failure; surgery; technique; total artificial heart