Ann Thorac Surg 2008;85:1205. doi:10.1016/j.athoracsur.2008.01.076
© 2008 The Society of Thoracic Surgeons
Original Articles: General Thoracic
Invited Commentary
Joseph Zwischenberger, MD
Department of Surgery, University of Kentucky College of Medicine, 800 Rose St, MN-264, Lexington, KY 40536-0298
(Email: j.zwische{at}uky.edu).
It has been more than 30 years since Dr Robert Bartlett began to clinically support the failing lungs of a neonate with a simplified, bedside cardiopulmonary bypass system. This system became known by the acronym ECMO, which stands for extracorporeal membrane oxygenation, and offered a new option in the management of severe cardiorespiratory failure in neonates, then children, then post-congenital heart patients, and then finally adults. The ECMO system allowed clinicians to support the failing lung or heart, or both, until the initiating disease process reversed or the patient recovered from the initial injury. The ECMO system also provided the first "bridge to transplant" technology. However, ECMO is complex, labor intensive, expensive, and requires a patient to remain bedridden in the intensive care unit setting. The ECMO system as a "bridge to heart transplant" has been mostly eliminated with the advent of the ventricular assist device (VAD), allowing patients the freedom to ambulate and in some cases even leave the hospital.
For the first time, Schmid and colleagues [1] report a patient managed with an extracorporeal (pulmonary artery–left atrial) shunt as a bridge to transplant that allowed for ambulation serving as a "less complicated" option to ECMO. The promise of this technology is to allow patients with end-stage lung disease awaiting transplant to escape from the confines of the hospital bed. Although the current version is invasive and has inherent physiologic uncertainties, the bench-to-bedside cycle has been completed. While ambulatory extracorporeal systems may evolve into different configurations or less invasive technology, this report should be regarded as proof of concept toward an ambulatory bridge to transplant system.
 |
References
|
|---|
- Schmid C, Philipp A, Hilker M, et al. Bridge to lung transplantation through a pulmonary artery to left atrial oxygenator circuit Ann Thorac Surg 2008;85:1202-1205.[Abstract/Free Full Text]
Top
References