Preliminary Result of an Algorithm to Select Proper Ventricular Assist Devices for High-Risk Patients with Extracorporeal Membrane Oxygenation Support
Resource
JOURNAL OF HEART AND LUNG TRANSPLANTATION v.20 n.8 pp.850-857
Journal
JOURNAL OF HEART AND LUNG TRANSPLANTATION
Journal Volume
v.20
Journal Issue
n.8
Pages
850-857
Date Issued
2001
Date
2001
Author(s)
CHEN, YIH-SHARNG
Abstract
Background: Extracorporeal membrane oxygenation (ECMO) is not suitable for longterm support because of its high incidence of complications. Conversion from ECMO to ventricular assist device (VAD) is reasonable, and we have developed a simple algorithm for selecting proper VADs for these ECMO-supported patients. Methods: We converted 12 patients who were receiving ECMO support to VAD for bridge to transplantation. Group I (n = 6) was converted directly from ECMO to VAD. Group II (it = 6) underwent stage conversion. We added left atrial drainage to ECMO because of lung edema or marked left heart distension. We discontinued drainage after recovery of right heart function. Group II had more unfavorable risk factors for VAD before ECMO. Results: Three patients (50%) in Group I received biventricular VADs. The other 3 patients were converted to left ventricular assist device (LVAD), but only 1 (16.7%) experienced successful conversion. We successfully converted 5 patients (83.3%) in Group IT to LVAD without right VAD, and 4 of them could be weaned from the ventilator. The multiple-organ dysfunction score gradually improved in Group II despite additional surgery. Two patients in each group received heart transplantation and survived long term. Conclusion: Using a conversion protocol provides a good guideline for making decisions. According to the protocol, right heart and pulmonary function can be clearly assured before shifting to LVAD in these critical ECMO-supported patients.
Subjects
LIFE-SUPPORT
TRANSPLANT
COMPLICATIONS
EXPERIENCE
BRIDGE
Type
journal article