Extracorporeal membrane oxygenation after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Issue 6 (24th April 2019)

• Record Type: Journal Article
• Authors: Sugiyama, Kayo; Suzuki, Shun; Fujiyoshi, Toshiki; Koizumi, Nobusato; Sato, Masato; Ogino, Hitoshi
• Is Part Of: Journal of cardiac surgery. Volume 34:Issue 6(2019)
• Page Start: 428
• Page End: 434
• Publication Date: 2019-04-24
• Subjects: chronic thromboembolic pulmonary hypertension -- extracorporeal membrane oxygenation -- pulmonary endarterectomy -- reperfusion pulmonary edema; Heart -- Surgery -- Periodicals; 617.412005
• DOI: 10.1111/jocs.14052
• Languages: English
• ISSNs: 0886-0440

Abstract

Abstract: Background: Pulmonary endarterectomy (PEA) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH) but can result in respiratory and cardiac complications that may require extracorporeal membrane oxygenation (ECMO). We reviewed our experience with ECMO in patients undergoing PEA. Methods and Results: Between January 2012 and August 2015, 35 patients underwent PEA for CTEPH. In all, four patients (11%) required veno‐arterial (V‐A) ECMO support due to severe cardiac and respiratory failure, including severe reperfusion pulmonary edema and persistent pulmonary hypertension. No significant differences in preoperative characteristics were found between patients who required ECMO and those who did not require ECMO. ECMO support was associated with a significantly higher incidence of postoperative respiratory complications, a longer intensive care unit stay, increased in‐hospital mortality, residual pulmonary hypertension, and postoperative balloon pulmonary angioplasty (BPA). The postoperative mean pulmonary artery pressure and pulmonary vascular resistance were significantly higher in patients requiring ECMO. All patients requiring ECMO were successfully weaned off ECMO support (100%), and three of them were discharged from the hospital alive (75%). Conclusions: Patients with CTEPH may benefit from ECMO after PEA for cardiac and respiratory complications. A prompt decision to use V‐A ECMO is critical for a successful outcome in these patients.