An Alternative Approach for Perioperative Extracorporeal Life Support Implantation.
Central veno-arterial extracorporeal membrane oxygenation (ECMO) is traditionally implanted using direct cannulation of the aorta and right atrium. We aim to summarize the outcome of patients who underwent perioperative central ECMO implantation using an alternative surgical approach, which allows sternum closure and does not require resternotomy at the time of explantation. We retrospectively reviewed patients who required veno-arterial ECMO support at our institution between January 2013 and July 2014. Inclusion criteria were patients undergoing central ECMO implantation using the above-mentioned implantation technique. Nine patients (65 ± 14 years) were supported using this technique. Four patients underwent coronary bypass surgery as a primary surgery and the other five patients had combined coronary and valve surgeries. The average duration of ECMO support was 9 ± 7 days (range 1-24 days). The dominant postoperative complication was renal failure, which occurred in eight patients (89%). In four patients (44%), the ECMO was successfully removed. Survival rate to discharge was 22%. In conclusion, this study showed the feasibility of this alternative ECMO implantation technique. No technical issues were encountered. Extended support duration and reducing resternotomy risks may be the main advantages of this technique compared with conventional ECMO implantation methods.
Clinic for Cardiovascular Surgery, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
Diyar
D
Saeed
Clinic for Cardiovascular Surgery, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
Bujar
B
Maxhera
Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
Ralf
R
Westenfeld
Clinic for Cardiovascular Surgery, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
Artur
A
Lichtenberg
Clinic for Cardiovascular Surgery, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
Alexander
A
Albert
D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D020878:Device Removal; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010107:Oxygenators, Membrane / Q000009:adverse effects; D010351:Patient Discharge; D019990:Perioperative Care; D020127:Recovery of Function; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
Cannulation technique; Cardiac surgery; Extracorporeal membrane oxygenation