Extracorporeal membrane oxygenation as perioperative right ventricular support in patients with biventricular failure undergoing left ventricular assist device implantation

Abstract

ECMO provided a satisfactory perioperative right-heart support in patients with preoperative biventricular failure undergoing LVAD implantations, who otherwise were better candidates for biventricular assist device. ECMO allowed time for the already compromised right ventricle to get attuned to the increasing preload, and avoids distension and RV failure.

Extra Corporeal Membrane Oxygenation as Right Heart Support Following Left Ventricular Assist Device Placement: A New Cannulation Technique

“…In these circumstances, supporting the right ventricle with a conventional Heart, Lung and Circulation Extra Corporeal Membrane Oxygenation and Left Ventricular Assist 2012;21:218-220 RVAD such as the Thoratec or Levotronix devices has been a common fall back position, but carries the dual disadvantages of adding considerable extra cost, and compromising the portable third generation LVAD which would allow the patient to be ambulatory. ECMO using an open chest technique has been described [5,6], however, our method of cannulation is novel and has some important advantages. ECMO is an established treatment for cardiac and/or respiratory failure [7,8].…”

Clinical use of venoarterial extracorporeal membrane oxygenation

“…An LVEF of >40%, LVOT VTI of >10 cm, and normal LV size all suggest a higher chance of successful weaning. [35][36][37] Even when the trial-off ECMO is successful, some centres will consider leaving the cannulae temporarily (<24 hours) in place in case the patient deteriorates. Continuous infusion of heparinised saline to these cannulae is necessary to avoid thrombus formation.…”

Devices in Heart Failure

“…82 ECMO involves surgical implantation of cannulae in a veno-arterial arrangement to support the RV in patients with pulmonary hypertension and massive pulmonary embolism, 83,84 as well as acute RV failure after heart transplantation. [85][86][87] Mechanical circulatory assist devices can be used with the inflow cannula in the RA or RV and out to the pulmonary artery or via venous-venous bypass if extracorporeal oxygenation is to be given. Such RV assist devices (RVAD) work at 4 L/min at 40 mmHg pulmonary pressure, 88 and include extracorporeal, paracorporeal, and implantable devices.…”