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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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 Is it out-of-date for non-pulsatile LVAD?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


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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.

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