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FASCICOLI E ARTICOLI   I PIÙ LETTI   eTOC

ULTIMO FASCICOLOTHE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632

Periodicità: Bimestrale

ISSN 0021-9509

Online ISSN 1827-191X

 

The Journal of Cardiovascular Surgery 2001 Agosto;42(4):457-63

CARDIAC SECTION 

 ORIGINAL ARTICLES

Conversion of extracorporeal membrane oxygenation to non-pulsatile left ventricular assist device. Is it out-of-date for non-pulsatile LVAD?

Chen Y. S., Ko W.-J., Chou T.-F., Chou N. K., Hsu R. B., Wang S. S., Lin F. Y., Chu S. H.

From ­the Department of Surgery National Taiwan University Hospital, Taipei, Taiwan

Background. Extracorporeal mem­brane oxy­gen­a­tion (­ECMO) pro­vides an imme­di­ate sup­port ­for ­acute dete­ri­ora­tion of hemo­dy­nam­ic ­and pul­mo­nary stat­us, ­but ­what is ­the ­best deci­sion ­for ­these crit­i­cal ­patients? Biventricular ­assist ­device (­BVAD) or ­left ven­tric­u­lar ­assist ­device (­LVAD)? We pro­posed a pro­to­col of ­step-by-­step con­ver­sion ­from ­ECMO to ­LVAD ­after assu­rance of ­the rever­sibil­ity of ­right ven­tri­cle ­and pul­mo­nary func­tion.
Methods. After femo­ral venoar­te­ri­al ­ECMO ­was insert­ed ­for ­the crit­i­cal ­patients, ­the ­left atri­al drain­age ­was add­ed to ­the ­ECMO first­ly ­and ­the femo­ral arte­ri­al ­inflow ­was shift­ed to ­the ascend­ing aor­ta ­for pre­vent­ing pos­sible periph­er­al vas­cu­lar com­pli­ca­tions. Tem-­porary ­clamp of ­right ­heart drain­age ­was ­tried to ­test ­right ­heart func­tion 24 to 48 ­hours lat­er. The ­sweep ­gas ­flow of oxy­gen­a­tor ­could be ­reduced grad­u­al­ly to ­test ­the pul­mo­nary func­tion. Therefore, ­the ­right ­heart ­drain ­and ­the oxy­gen­a­tor ­could be with­drawn to ­become a ­non-pul­sa­tile ­LVAD or ­shift to pneu­mat­ic ­LVAD direct­ly. There ­were four clin­i­cal expe­ri­enc­es ­with suc­cess­ful con­ver­sion with­out tem­po­rary ­right ven­tric­u­lar ­assist ­device.
Results. All of ­them ­were ­able to con­vert ­their ­ECMO to ­LVAD smooth­ly in 8.0±2.5 ­days. Three of ­them ­were shift­ed to ­non-pul­sa­tile ­LVAD, ­and ­one ­was con­vert­ed to HeartMate. All ­but ­one ­could be ­weaned ­from ­the ven­ti­la­tor. No ­BVAD ­was need­ed in ­these ­patients. Due to ­the short­age of ­donor ­hearts, ­only ­one ­had ­the ­chance to under­go ­heart trans­plan­ta­tion.
Conclusions. The pro­to­col ­did pro­vide a ­good guide­line ­for deci­sion-mak­ing ­for ­those ­under ­ECMO sup­port neces­si­tat­ing ­bridge to trans­plan­ta­tion.

lingua: Inglese


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