title: Role of extracorporeal life support after pulmonary endarterectomy: a single-centre experience.
abstract: Extracorporeal life support (ECLS) for rescue after pulmonary endarterectomy (PEA) has become a viable option. This study aims to present a single-centre experience looking at the indications and outcome of ECLS after PEA.
  
  
  
  Retrospective analysis of all patients undergoing PEA from January 2008 to January 2015 in our institution.
  
  
  
  Among 144 consecutive patients undergoing PEA for chronic thromboembolic pulmonary hypertension, 6 (4%) received ECLS postoperatively for right ventricular (RV) failure (n = 3), severe hypoxaemia (n = 2) and haemorrhagic pulmonary oedema (n = 1). ECLS configuration was central veno-arterial (cVA) in 3 patients, peripheral VA (pVA) in 1 and veno-venous (VV) in 2. One patient with cVA was switched to VV after 5 days. Overall ECLS duration ranged between 3 and 39 (median 5) days. ECLS patients had higher preoperative total pulmonary vascular resistance (TPR) compared with non-ECLS patients (1477 ± 671 vs 954 ± 462 Dynes.s.cm(-5), P = 0.009) and more frequently required hospital admission for RV failure before surgery (50 vs 9%, P = 0.02). The overall in-hospital mortality rate for all patients was 2% (3/144), including one ECLS patient on pVA. The remaining 5 ECLS patients (83%) were discharged from the hospital and are alive after a median follow-up of 11 (range 6-27) months. Two ECLS patients (40%) are on therapy for residual PH compared with 13 (10%) in the non-ECLS patients (P = 0.09).
  
  
  
  ECLS is a safe and important rescue option after PEA. The use of ECLS may expand eligibility for PEA by allowing sicker patients to undergo surgery.
authors.affiliation: Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada laura.donahoe@uhn.ca.
authors.forename: Laura
authors.initials: L
authors.lastname: Donahoe
authors.affiliation: Division of Respirology, University of Toronto, Toronto, ON, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Granton
authors.affiliation: Department of Anaesthesia, University of Toronto, Toronto, ON, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: McRae
authors.affiliation: Division of Respirology, University of Toronto, Toronto, ON, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Thenganatt
authors.affiliation: Division of Respirology, University of Toronto, Toronto, ON, Canada.
authors.forename: Jacov
authors.initials: J
authors.lastname: Moric
authors.affiliation: Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Shaf
authors.initials: S
authors.lastname: Keshavjee
authors.affiliation: Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: de Perrot
mesh_terms: D000328:Adult; D000368:Aged; D004691:Endarterectomy / Q000009:adverse effects*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011654:Pulmonary Edema / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D011655:Pulmonary Embolism / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014655:Vascular Resistance; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000401:mortality / Q000628:therapy*
keywords: Extracorporeal life support; Pulmonary endarterectomy; Pulmonary hypertension