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Ann Thorac Surg 2006;82:2139-2145
© 2006 The Society of Thoracic Surgeons
a Division of Cardiothoracic Surgery, University of California, San Diego, San Diego, California
b Division of Biostatistics, University of California, San Diego, San Diego, California
c Division of Pulmonary and Critical Care Medicine, University of California, San Diego, San Diego, California
Accepted for publication July 6, 2006.
* Address correspondence to Dr Thistlethwaite, Division of Cardiothoracic Surgery, University of California, San Diego, San Diego, CA 92103-8892. (Email: pthistlethwaite{at}ucsd.edu).
BACKGROUND: Pulmonary endarterectomy is the accepted therapy for thromboembolic pulmonary hypertension. A recognized complication of this surgery is the postoperative development of reperfusion edema, a potentially fatal cause of respiratory failure. Because reperfusion edema can be a reversible process, temporizing support measures may be life saving.
METHODS: We retrospectively reviewed our experience with venovenous extracorporeal life support (V-V ECLS) from July 1990 to February 2006, in 20 adult patients (mean age 50.5 ± 14.5 years) presenting with potentially reversible respiratory failure after pulmonary endarterectomy. This subset of patients comprised 1.12% of our total pulmonary endarterectomy experience during that time (1,790 cases).
RESULTS: Overall in-hospital survival was 30.0% for patients requiring ECLS support after pulmonary endarterectomy versus 94.2% for patients who underwent pulmonary endarterectomy alone during the same timeframe. V-V ECLS was instituted at a mean of 86.8 hours after surgery. The mean duration of V-V ECLS was 123.4 ± 71.3 hours. The most common cause of death in ECLS patients after pulmonary endarterectomy was pulmonary hemorrhage. Survival was greater in patients cannulated within 120 hours of surgery (46.2% survival; 6 of 13 patients) compared with those cannulated after 120 hours (0 of 7 patients). Multiple logistic regression identified long duration of mechanical ventilation pre-ECLS and severity of preoperative pulmonary hypertension together as predictors of mortality.
CONCLUSIONS: A small subset of patients undergoing pulmonary endarterectomy develop temporary life-threatening respiratory failure secondary to severe reperfusion edema. In those patients with satisfactory hemodynamic outcome, V-V ECLS is a therapeutic option when all other conventional strategies have been exhausted.
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Ann. Thorac. Surg. 2006 82: 2145-2146.
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J. M. Albes Invited commentary Ann. Thorac. Surg., December 1, 2006; 82(6): 2145 - 2146. [Full Text] [PDF]
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