Perioperative extracorporeal membrane oxygenation bridging in patients undergoing pulmonary endarterectomy

Nierlich, Patrick; Ristl, Robin

doi:10.1093/icvts/ivv318

Cited by 24 publications

(45 citation statements)

References 17 publications

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“…The use of ECMO after PTE has been reported in 9% to 19% of patients, at specialized centers, with in-hospital mortality ranging from 57% to 66% in these patients. 6,10 Venoarterial (VA) ECMO for RV dysfunction in the perioperative period in patients with CTEPH carries several limitations. As a biventricular unloading strategy, VA ECMO limits the ability to assess both left and right ventricular function independent of each other.…”

Section: Discussionmentioning

confidence: 99%

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Minimally Invasive Mechanical Circulatory Support Through the Perioperative Pulmonary Thromboendarterectomy Period: A Case Report

Schurman

Cain

Joyce

et al. 2020

Innovations�(Phila)

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A 64-year-old man being evaluated for pulmonary thromboendarterectomy (PTE) preoperatively experienced pulseless electrical activity secondary to right ventricular failure while undergoing bronchoscopy. After return of spontaneous circulation, a percutaneous right ventricular assist device (RVAD) was placed through the right internal jugular vein. He continued on right ventricular support with demonstration of right ventricular recovery over the following 8 days, and subsequently underwent PTE for treatment of his primary condition. He recovered and was weaned from his RVAD support uneventfully. The need for RVAD support has traditionally been a contraindication for PTE; however, circulatory assist devices have been used as a salvage procedure for right-heart failure after PTE. This case highlights the potential for percutaneous mechanical circulatory support in treating severe perioperative right ventricular dysfunction, and to facilitate successful recovery in patients undergoing PTE.

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Section: Discussionmentioning

confidence: 99%

“…4,5 Extracorporeal membrane oxygenation (ECMO) has been used to salvage patients with RV or respiratory failure in the postoperative setting after PTE, but the preoperative use of ECMO or ventricular assistance has been limited. 4 -6…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Mechanical Circulatory Support Through the Perioperative Pulmonary Thromboendarterectomy Period: A Case Report

Schurman

Cain

Joyce

et al. 2020

Innovations�(Phila)

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“…For these difficult situations, postoperative ECMO is essential and recommended as a standard of care in pulmonary hypertension centers. According to previous retrospective studies [6,7], approximately 4%–20% of patients required postoperative extracorporeal life support. Atrial septostomy was traditionally used as an effective palliative treatment for right heart failure in severe PH cases.…”

Section: Discussionmentioning

confidence: 99%

“…In this situation, the two major treatment options were lung transplantation or medical treatment, including balloon pulmonary angioplasty. Lung transplantation was considered the inferior option for the following reasons: (1) the patient was young, and the 5-year survival rate is only approximately 50% following transplantation [10], which, in her case, would be worse considering her thrombogenic and postoperative condition, which requires extracorporeal life support [7,11,12]; (2) she was returning to a good performance state through early rehabilitation with central-type ECMO support; and (3) there would be additional opportunities to modify her medication or perform balloon angioplasty after resolving acute thrombi. Sequential pulmonary balloon angioplasty for distal arteries has been recently used for selected inoperable CTEPH patients or patients with residual or recurrent PH after successful PEA [13-15].…”

Section: Discussionmentioning

confidence: 99%

Central extracorporeal membrane oxygenation and early rehabilitation for persistent severe pulmonary hypertension following pulmonary endarterectomy

et al. 2019

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Chronic thromboembolic pulmonary hypertension is potentially curable with a pulmonary endarterectomy. However, approximately 20% of patients have persistent pulmonary hypertension after pulmonary endarterectomy, which is a major risk factor for postoperative death. Here, we report a 34-year-old woman who suffered persistent severe pulmonary hypertension following a successful pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Extracorporeal membrane oxygenation (ECMO) and atrial septostomy were successfully performed as rescue treatments, and active rehabilitation during ECMO was prescribed to facilitate recovery.

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“…In the Cambridge PEA group, the incidence of post-PEA ECMO was 5.5% (7/127 patients) with 71.4% of patients (5/7) weaned and 57.1% (4/7 patients) discharged. While they cannulate the right atrium and aorta (central cannulation), other groups favor the peripheral approach (8,9). The Vienna group (9) reports a rate of ECMO weaning of 90.3% (28 of 31 patients on ECMO), while the overall need for ECMO was 19.3% (31 patients of 161 PEA population).…”

Section: Introductionmentioning

confidence: 99%

Role and management of extracorporeal life support after surgery of chronic thromboembolic pulmonary hypertension

Suàrez¹,

Gliozzi²,

Fiorentino³

et al. 2019

Ann. Cardiothorac. Surg.

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Background: Pulmonary endarterectomy (PEA) is a surgical intervention reserved for patients with chronic thromboembolic pulmonary hypertension (CTEPH). In some cases, temporary circulatory support [extracorporeal life support (ECLS)] is required after PEA. Rates of ECLS requirement varies between centers. Reasons for institution of ECLS include respiratory failure, cardiac failure (or both respiratory and cardiac failure), bleeding, and reperfusion edema. This article reviews the experience of ECLS after PEA from the current literature, as well as our own institution's experience as a CTEPH multidisciplinary center. Methods: A literature review was conducted along with a retrospective chart review from 15 years of our PEA program. Results: The literature demonstrates many different approaches are used for mechanically supporting patients who develop complications after PEA. Variations in approach stem from differing indications such as, respiratory failure rather than hemodynamic compromise (or vice versa), time of implantation (immediately in operating room or delayed after surgery) and many other causes. In our center, 12.3% (19/154) of patients need ECLS with extracorporeal membrane oxygenator (ECMO) after PEA procedure. Implantation was mainly in the operating room before or immediately after weaning from cardiopulmonary bypass and mostly peripheral cannulation was used. ECMO lasted an average of 11±8 days. And 52.6% (10 of 19 patients) of patients were weaned from ECLS and of this, 70% (7 of 10 patients) were discharged. Conclusions: In some cases of PEA, ECLS is needed post-operatively. Expert teams should consider this possibility pre-operatively based on predisposing characteristics. The need for ECMO shouldn't be "di per se" a contraindication to surgery but might be considered in the surgical risk estimation. The ideal setup is not fixed and depends on the center's practices as well as indication. Even though complications do occur with ECMO, in general, results are good, being a bridge to further recovery of pulmonary hypertension (PH) or also to transplantation.

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Perioperative extracorporeal membrane oxygenation bridging in patients undergoing pulmonary endarterectomy

Abstract: Pre- and postoperative ECMO bridging in patients undergoing PEA is a feasible option to stabilize patients in a critical pre- and/or postoperative situation and to improve outcome in these patients who would otherwise probably not survive the procedure.

Cited by 24 publications

References 17 publications

Minimally Invasive Mechanical Circulatory Support Through the Perioperative Pulmonary Thromboendarterectomy Period: A Case Report

Minimally Invasive Mechanical Circulatory Support Through the Perioperative Pulmonary Thromboendarterectomy Period: A Case Report

Central extracorporeal membrane oxygenation and early rehabilitation for persistent severe pulmonary hypertension following pulmonary endarterectomy

Role and management of extracorporeal life support after surgery of chronic thromboembolic pulmonary hypertension

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