Bridging to lung transplantation for severe pulmonary hypertension using dual central Novalung lung assist devices

Abstract

This case describes the technique of using dual Novalungs (a pumpless extracorporeal system) to bridge a patient with idiopathic pulmonary hypertension to bilateral lung transplantation. A 41-year old lady with idiopathic pulmonary hypertension (with a possible veno-occlusive element) presented with symptoms of end-stage heart and lung failure. This was refractory to medical management with iloprost, sildenafil and bosentan. The patient was placed on the urgent waiting list for lung transplantation and central pulmonary artery to left atrial Novalung insertion was performed. Local anaesthetic was given before performing peripheral cardiopulmonary bypass due to the high risk of cardiac arrest. Two days later, donor organs became available and the patient was taken for double-lung transplantation. The pulmonary artery cannula was removed leaving a large defect. This was then closed using a bovine pericardial patch. Due to the damaged right superior pulmonary vein from Novalung cannulation, cardioplegia was given to facilitate an open atrial anastomosis. After 13 days in the intensive therapy unit, she was transferred to the ward. There were no further complications and she has been discharged home.

Extracorporeal life support as a bridge to lung transplantation–experience of a high-volume transplant center

“…This concept has recently been adopted by others. 24,25 Besides PA/LA Novalung and VA ECMO, there are novel approaches to bridge patients with IPAH. Based on previous animal experiments, Camboni and colleagues 26 and Kon and colleagues 27 have advocated an atrial septostomy (to decompress the failing right heart) and a VV single dual-lumen cannula ECMO to overcome the desaturation resulting from the artificial right-to-left shunt.…”

Lung Transplantation and Precision Medicine

“…Another new development in lung transplantation is the use of extracorporeal lung support, which can be utilized to bridge deteriorating patients to lung transplantation. This is not a commonly used technique, although there are promising results, with bridging up to 140 days, which could reduce mortality on the waiting list [27][28][29][30].…”

Cannulation techniques for extracorporeal life support

“…The most common indication for this type of respiratory support is bridge to lung transplantation in patients with pulmonary hypertension. Among the advantages of this paracorporeal support is ability to provide decarboxylation, oxygenation, RV remodelling and greater scope for ambulation (22,24,25).…”