Open AccessPercutaneous Mechanical Circulation Support Combined with Extracorporeal Membrane Oxygenation (oxyRVAD) in Secondary Right Heart Failure
Author(s) -
Philipp M. Lepper,
Sabrina I. Hörsch,
Frederik Seiler,
A Kamp,
Sören L. Becker,
Christian Lensch,
Lars O. Conzelmann,
Hendrik Haake,
Ralf Michael Muellenbach,
Robert Bals,
Markus Kredel,
Frank Langer,
Heinrike Wilkens,
F Trudzinski
Publication year - 2018
Publication title -
asaio journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.961
H-Index - 66
eISSN - 1538-943X
pISSN - 1058-2916
DOI - 10.1097/mat.0000000000000754
Subject(s) - extracorporeal membrane oxygenation , medicine , ventricle , cardiology , percutaneous , cannula , extracorporeal circulation , circulatory system , heart failure , cardiogenic shock , surgery , myocardial infarction
Right heart failure (RHF) because of pulmonary hypertension (PH) is a frequently encountered clinical problem with high mortality. The last resort, if pharmacological therapy fails, is mechanical circulatory support. There is a lack of percutaneous systems to support the right ventricle (RV). Venoarterial extracorporeal membrane oxygenation is widely used as a bailout in acute RHF in non-left ventricular assist device patients. Venoarterial extracorporeal membrane oxygenation does not unload the left ventricle and may cause failure of the left ventricle if used for a longer period of time. We report the long-term use of an ECMO-based percutaneous right ventricular assist system (oxyRVAD) capable to deliver up to 6 L/min of blood flow with a returning cannula placed in the main pulmonary artery used in RHF originating from PH with poor oxygenation. We present a series of four patients on oxyRVAD (mean treatment duration 15 ± 7.6 days). Patients benefited from the system clinically; however, two patients eventually died while on oxyRVAD. Nevertheless, we provide a proof-of-concept of this system in PH patients, which is feasible and might provide a useful "bridge-to-recovery" or "bridge-to-transplant" option in the management of patients with severe RHF because of PH.