Extracorporeal Life Support After Pulmonary Endarterectomy as a Bridge to Recovery or Transplantation: Lessons From 31 Consecutive Patients.
BACKGROUND
Extracorporeal life support (ECLS) can be used to sustain patients having cardiorespiratory failure after pulmonary endarterectomy (PEA). We aimed to assess outcomes and to identify factors associated with short-term survival among patients who required ECLS after PEA.


METHODS
We reviewed the charts of consecutive patients who required ECLS after PEA between 2005 and 2013 at our institution. Patients with failed PEA were scheduled for heart-lung transplantation, and patients with potentially reversible hemodynamic or respiratory failure were given appropriate supportive care until recovery.


RESULTS
Of the 829 patients who underwent PEA, 31 (3.7%) required postoperative ECLS. Of these, 23 continued to receive support, and 8 were listed for heart-lung transplantation during ECLS. Overall inhospital survival was 48.4% (15 of 31). Of patients listed for transplantation, 2 died while on support; 4 of the 6 patients undergoing transplantation lived to hospital discharge. Of the 23 supportive care patients, 11 (47.8%) were alive at hospital discharge. The factors associated with survival were younger age (p = 0.02), larger post-PEA decrease in mean pulmonary artery pressure (p = 0.020), lower post-PEA total pulmonary resistance (p = 0.008), and pure respiratory failure related to reperfusion edema or airway bleeding (p = 0.003).


CONCLUSIONS
Extracorporeal life support may be useful to support patients with complications after PEA either to recovery or to salvage transplantation.
Department of Thoracic, Vascular, and Heart-Lung Transplantation, Marie Lannelongue Hospital, Le Plessis-Robinson, Paris South University, France.
David
D
Boulate
Department of Thoracic, Vascular, and Heart-Lung Transplantation, Marie Lannelongue Hospital, Le Plessis-Robinson, Paris South University, France. Electronic address: o.mercier@ccml.fr.
Olaf
O
Mercier
Department of Thoracic, Vascular, and Heart-Lung Transplantation, Marie Lannelongue Hospital, Le Plessis-Robinson, Paris South University, France.
Sacha
S
Mussot
Department of Thoracic, Vascular, and Heart-Lung Transplantation, Marie Lannelongue Hospital, Le Plessis-Robinson, Paris South University, France.
Dominique
D
Fabre
Adult Intensive Care Unit, Marie Lannelongue Hospital, Le Plessis-Robinson, Paris South University, France.
François
F
Stephan
Cardiovascular Medicine, Stanford Hospital, Stanford University, California.
François
F
Haddad
Department of Pulmonology and Respiratory Intensive Care, Bicêtre Hospital, Le Kremlin-Bicêtre, Paris South University, France.
Xavier
X
Jaïs
Department of Thoracic, Vascular, and Heart-Lung Transplantation, Marie Lannelongue Hospital, Le Plessis-Robinson, Paris South University, France.
Philippe
P
Dartevelle
Department of Thoracic, Vascular, and Heart-Lung Transplantation, Marie Lannelongue Hospital, Le Plessis-Robinson, Paris South University, France.
Elie
E
Fadel
D000792:Angiography; D004691:Endarterectomy / Q000009:adverse effects*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D016041:Heart-Lung Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D020127:Recovery of Function; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome