Large animal preclinical investigation into the optimal extracorporeal life support configuration for pulmonary hypertension and right ventricular failure

Ukita, Rei; Stokes, John W.; Wu, Wei; Patel, Yatrik J; Talackine, Jennifer; Cardwell, Nancy L.; Benson, Clayne; Lefevre, Ryan J.; Eagle, Susan; Demarest, Caitlin T.; Simonds, Elizabeth M; Tipograf, Yuliya; Cortelli, Michael; Skoog, David J.; Cook, Keith E.; Rosenzweig, Erika B.; Bacchetta, Matthew

doi:10.1016/j.healun.2022.10.023

Cited by 4 publications

(1 citation statement)

References 47 publications

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“…The RA to LA ECMO ( N = 3) achieved interventricular septal normalization, RV unloading, and LV restoration with increasing flow. 16 Therefore, we think the risk of this cannulation strategy would be overloading the atrophied LV, not underfilling the hypertrophied RV.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Transseptal Extracorporeal Membrane Oxygenation to Rescue a Failing Right Ventricle in an Animal Model

Castillo-Larios,

Pollak,

Chaudhary

et al. 2023

Innovations�(Phila)

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Objective: We tested the feasibility and effectiveness of a percutaneous atrial transseptal extracorporeal membrane oxygenation (ECMO) cannulation strategy in a right ventricular failure (RVF) model. Methods: We performed 4 nonsurvival porcine experiments. Percutaneous transseptal access was achieved using a steerable introducer. For guidance, we used fluoroscopy, transesophageal echocardiogram (TEE), and intracardiac echocardiography (ICE). A ProtekDuo rapid deployment cannula (LivaNova, London, UK) was advanced across the septum into the left atrium by 2 to 3 cm. Pulmonary hypertension (PH) was induced by partially clamping the pulmonary artery. ECMO flow was cycled from high (2 to 3 L/min) to low (0.2 to 0.3 L/min) over 2 to 3 hours. Results: Transseptal access using TEE and fluoroscopy was successful in 1 animal and unsuccessful in 1 animal. ICE provided optimal visualization for the remaining 2 animals. Mean arterial pressure (MAP) was associated immediately and consistently with high versus low ECMO flow rate (mean difference: 29 ± 3.1 mm Hg, P = 0.004) but was not restored to baseline values. RV pressure values were dynamic. Given time to equilibrate, mean RV pressure was restored to a baseline level. Conclusions: Percutaneous right atrium to left atrium transseptal cannulation relieved PH-RVF. MAP was restored to a viable level, and mean RV pressure was restored to a baseline level. Transseptal ECMO shows promise as a cannulation strategy to bridge patients with PH-RVF to lung transplant.

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Section: Discussionmentioning

confidence: 99%

Percutaneous Transseptal Extracorporeal Membrane Oxygenation to Rescue a Failing Right Ventricle in an Animal Model

Castillo-Larios,

Pollak,

Chaudhary

et al. 2023

Innovations�(Phila)

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A Dynamic Sheep Model to Induce Pulmonary Hypertension and Right Ventricular Failure

Johnson,

Cortelli,

Glomp

et al. 2024

Methods in Molecular Biology

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Progress towards permanent respiratory support

Shin,

Nasim,

O’Connor

et al. 2024

Current Opinion in Organ Transplantation

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Purpose of review Although lung transplantation stands as the gold standard curative therapy option for end-stage lung disease, the scarcity of available organs poses a significant challenge in meeting the escalating demand. This review provides an overview of recent advancements in ambulatory respiratory assist systems, selective anticoagulation therapies that target the intrinsic pathway, and innovative surface coatings to enable permanent respiratory support as a viable alternative to lung transplantation. Recent findings Several emerging ambulatory respiratory assist systems have shown promise in both preclinical and clinical trials. These systems aim to create more biocompatible, compact, and portable forms of extracorporeal membrane oxygenation that can provide long-term respiratory support. Additionally, innovative selective anticoagulation strategies, currently in various stages of preclinical or clinical development, present a promising alternative to currently utilized nonselective anticoagulants. Moreover, novel surface coatings hold the potential to locally prevent artificial surface-induced thrombosis and minimize bleeding risks. Summary This review of recent advancements toward permanent respiratory support summarizes the development of ambulatory respiratory assist systems, selective anticoagulation therapies, and novel surface coatings. The integration of these evolving device technologies with targeted anticoagulation strategies may allow a safe and effective mode of permanent respiratory support for patients with chronic lung disease.

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Large animal preclinical investigation into the optimal extracorporeal life support configuration for pulmonary hypertension and right ventricular failure

Cited by 4 publications

References 47 publications

Percutaneous Transseptal Extracorporeal Membrane Oxygenation to Rescue a Failing Right Ventricle in an Animal Model

Percutaneous Transseptal Extracorporeal Membrane Oxygenation to Rescue a Failing Right Ventricle in an Animal Model

A Dynamic Sheep Model to Induce Pulmonary Hypertension and Right Ventricular Failure

Progress towards permanent respiratory support

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