Role of extracorporeal life support after pulmonary endarterectomy: a single-centre experience

Donahoe, Laura; Granton, John; McRae, Karen; Thenganatt, John; Moric, Jakov; Keshavjee, Shaf; Perrot, Marc de

doi:10.1093/icvts/ivw075

Cited by 16 publications

(17 citation statements)

References 15 publications

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“…Although intra-aortic balloon counterpulsation and short-term RV-assist device support have been used for RV failure after cardiac surgery and PTE, 130,131 most clinicians have moved toward venovenous (VV) and VA ECMO as a bridge to recovery or bridge to transplantation. [132][133][134] Pulmonary hemorrhage, pneumonia, and RV failure are the most common pathologies resulting in ECMO support. The decision of initiation and timing is complex and is made in consideration of patient-specific, provider, and institutional factors.…”

Section: Extracorporeal Life Supportmentioning

confidence: 99%

Critical Care of Patients After Pulmonary Thromboendarterectomy

Kratzert

Boyd

Saggar

et al. 2019

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Extracorporeal Life Supportmentioning

confidence: 99%

Critical Care of Patients After Pulmonary Thromboendarterectomy

Kratzert

Boyd

Saggar

et al. 2019

Journal of Cardiothoracic and Vascular Anesthesia

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“…ECLS is a well-established therapy in many cardiorespiratory and hemodynamic conditions, thanks to a number of technical and material improvements that allow better coagulation management, less inflammatory response and better gas exchange (22).…”

Section: Discussionmentioning

confidence: 99%

Role and management of extracorporeal life support after surgery of chronic thromboembolic pulmonary hypertension

Suàrez¹,

Gliozzi²,

Fiorentino³

et al. 2019

Ann. Cardiothorac. Surg.

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Background: Pulmonary endarterectomy (PEA) is a surgical intervention reserved for patients with chronic thromboembolic pulmonary hypertension (CTEPH). In some cases, temporary circulatory support [extracorporeal life support (ECLS)] is required after PEA. Rates of ECLS requirement varies between centers. Reasons for institution of ECLS include respiratory failure, cardiac failure (or both respiratory and cardiac failure), bleeding, and reperfusion edema. This article reviews the experience of ECLS after PEA from the current literature, as well as our own institution's experience as a CTEPH multidisciplinary center. Methods: A literature review was conducted along with a retrospective chart review from 15 years of our PEA program. Results: The literature demonstrates many different approaches are used for mechanically supporting patients who develop complications after PEA. Variations in approach stem from differing indications such as, respiratory failure rather than hemodynamic compromise (or vice versa), time of implantation (immediately in operating room or delayed after surgery) and many other causes. In our center, 12.3% (19/154) of patients need ECLS with extracorporeal membrane oxygenator (ECMO) after PEA procedure. Implantation was mainly in the operating room before or immediately after weaning from cardiopulmonary bypass and mostly peripheral cannulation was used. ECMO lasted an average of 11±8 days. And 52.6% (10 of 19 patients) of patients were weaned from ECLS and of this, 70% (7 of 10 patients) were discharged. Conclusions: In some cases of PEA, ECLS is needed post-operatively. Expert teams should consider this possibility pre-operatively based on predisposing characteristics. The need for ECMO shouldn't be "di per se" a contraindication to surgery but might be considered in the surgical risk estimation. The ideal setup is not fixed and depends on the center's practices as well as indication. Even though complications do occur with ECMO, in general, results are good, being a bridge to further recovery of pulmonary hypertension (PH) or also to transplantation.

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“…However, distal lesions and high PVR alone must not be considered formal contraindications for surgery. In many series, patients with a need for ECLS often demonstrated preoperative high PVR and previous signs and symptoms of RV failure [9,11,[13][14][15].…”

Section: Perioperative Role and Indications Of Ecls In Peamentioning

confidence: 99%

“…Many centers reported their experience in PEA, focusing on perioperative ECLS: there is no consensus on the best strategy, because of multiple possible indications and approaches, but many authors recommend a prompt, aggressive treatment with ECLS before severe end-stage organ hypoperfusion, possibly with a tailored approach [15,18].…”

Section: Surgical Strategies and Ecls Setupmentioning

confidence: 99%

The Role of Extracorporeal Membrane Oxygenation Support after Pulmonary Thrombo-Endarterectomy

Loforte¹,

Gliozzi²,

Cavalli³

et al. 2023

Extracorporeal Membrane Oxygenation Support Therapy

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Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare consequence of acute or chronic pulmonary embolism. Pulmonary endarterectomy (PEA) is the gold standard treatment: expert centers are able to offer this challenging procedure with low in-hospital mortality, excellent hemodynamic results, and significant improvement in exercise tolerance and quality of life. Despite careful preoperative selection and increasing technical experience in PEA, some patients may suffer from life-threatening complications requiring extracorporeal life support (ECLS). ECLS is necessary in case of heart failure, respiratory failure, or both. According to different indications and timing, cardiopulmonary failure after PEA should be managed with a tailored approach: veno-venous or veno-arterial support, and central or peripheral cannulation. In the present chapter, causes, management strategies, and outcomes of perioperative ECLS for PEA are discussed.

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Role of extracorporeal life support after pulmonary endarterectomy: a single-centre experience

Abstract: ECLS is a safe and important rescue option after PEA. The use of ECLS may expand eligibility for PEA by allowing sicker patients to undergo surgery.

Cited by 16 publications

References 15 publications

Critical Care of Patients After Pulmonary Thromboendarterectomy

Critical Care of Patients After Pulmonary Thromboendarterectomy

Role and management of extracorporeal life support after surgery of chronic thromboembolic pulmonary hypertension

The Role of Extracorporeal Membrane Oxygenation Support after Pulmonary Thrombo-Endarterectomy

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