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Original Articles: Adult Cardiac

Successful Extracorporeal Membrane Oxygenation Support After Pulmonary Thromboendarterectomy

^a Department of Cardiothoracic Surgery, Papworth Hospital, Papworth Everard, Cambridge, United Kingdom
^b Department of Anesthesia and Intensive Care, Papworth Hospital, Papworth Everard, Cambridge, United Kingdom
^c Cambridge Perfusion Services, Papworth Hospital, Papworth Everard, Cambridge, United Kingdom

Accepted for publication June 10, 2008.

^_* Address correspondence to Dr Jenkins, Papworth Hospital, Cambridge, CB23 3RE, United Kingdom (Email: david.jenkins{at}papworth.nhs.uk).

Background: Pulmonary thromboendarterectomy (PTE) is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension. However, some patients develop severe cardiorespiratory compromise soon after separating from cardiopulmonary bypass, either from early reperfusion pulmonary edema or right ventricular failure secondary to residual pulmonary hypertension. Since 2005 we have used venoarterial extracorporeal membrane oxygenation (ECMO) support in this group that has no other therapeutic option. We review our experience of early ECMO support in the severely compromised patient's post-PTE.

Methods: We conducted a retrospective review of all patients undergoing PTE from a single national referral center between August 2005 and August 2007.

Results: One hundred twenty-seven consecutive patients underwent PTE surgery. Seven patients (5.5%) had extreme cardiorespiratory compromise in the immediate postoperative period and required venoarterial ECMO support. Their mean age was 51.3 years with 3 males. When compared with patients not requiring ECMO, these patients had significantly poorer hemodynamic indices before the operation with mean pulmonary artery pressure of 62 mm Hg versus 51 mm Hg (p = 0.02) and pulmonary vascular resistance of 907 dynes/sec/cm^–5 versus 724 dynes/s^–1/cm^–5 (p < 0.02). Mean duration of support was 119 hours (49 to 359 hours). Five patients were successfully weaned from ECMO support (73%) and 4 left the hospital alive, giving a salvage rate of 57%. For those who did not require ECMO support, hospital mortality was 4.2%.

Conclusions: Early venoarterial ECMO support has a role as rescue therapy post-PTE in patients with severe compromise who would probably otherwise die.

Related Article

Invited Commentary

Stuart W. Jamieson and Michael Madani
Ann. Thorac. Surg. 2008 86: 1267. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				M. Berman, E. Pavlushkov, E. Abraham, J. Dunning, S. Tsui, R. Hall, A. Klein, and D. P. Jenkins Pulmonary endarterectomy - an example of treatment of right ventricular after load failure MMCTS, June 12, 2009; 2009(0612): 3491. [Abstract] [Full Text] [PDF]

				S. W. Jamieson and M. Madani Invited Commentary Ann. Thorac. Surg., October 1, 2008; 86(4): 1267 - 1267. [Full Text] [PDF]