Extracorporeal membrane oxygenation support for right ventricular failure after left ventricular assist device implantation†

Abstract

Temporary ECMO-facilitated RV support is associated with good long-term outcomes and high rates of RV recovery.

Опыт Персонализации Лечения У Педиатрических Пациентов С Имплантированными Устройствами Механической Поддержки Левого Желудочка В Раннем Послеоперационном Периоде

“…Some data suggest that ECMO should be generally viewed as increasing the risk of LVAD support in the majority of children. On the other hand, it is possible that ECMO [11], when used strictly for short-term resuscitative support to normalize end-organ function immediately prior to VAD implant, may improve LVAD candidacy in selected patients. Patients with significant problems due to left ventricular function very frequently have a concomitant right ventricular dysfunction, so the decision must be reached whether the patient needs LVAD only or biventricular MCS system implantation.…”

Extracorporeal membrane oxygenation for right ventricular support in left ventricular assist device recipients

“…Since the patient had a preoperatively impaired right ventricular (RV) function, we decided to leave the ECMO in place for temporary RV support in order to avoid possible perioperative RV failure (2)(3)(4). The LVAD and the ECMO flow are set under TEE control.…”

“…On the other hand, temporary RVAD systems can cause pulmonary edema when set to inappropriately high flow. We always adjust the flow of both machines under echocardiography guidance: both ventricles should be decompressed, the septum position should be neutral to rightward and suction has to be avoided (2).…”

Pediatric Patients With Implanted Left Ventricular Assist Devices End Expiriense of Personalization of Treatment in Early Postoperative Period

“…Some data suggest that ECMO should be generally viewed as increasing the risk of LVAD support in the majority of children. On the other hand, it is possible that ECMO [11], when used strictly for shortterm resuscitative support to normalize end-organ function immediately prior to VAD implant, may improve LVAD candidacy in selected patients. Patients with significant problems with left ventricle function have very frequently concomitant right ventricular dysfunction, so the decision must be reached whether the patient needs LVAD only or the biventricular MCS system implantation.…”