Evaluation of dual-lumen pulmonary artery cannulation in extracorporeal right ventricular support
Journal
JTCVS Open
Start Page
101699
ISSN
2666-2736
Date Issued
2026-03
Author(s)
Lo Coco, Valeria
Di Mauro, Michele
Mariani, Silvia
Bidar, Elham
Hryniewicz, Kasia
Loforte, Antonio
Fux, Thomas
Heuts, Sam
Wiedemann, Dominik
Kawcynsky, Michal
Verbelen, Tom
Broman, Lars Mikael
Kremer, Jamila
Pozzi, Matteo
Takeda, Koji
Boeken, Udo
Masiello, Paolo
Vogel, Dominik J.
Maas, Jacinta J.
Ballotta, Andrea
Pappalardo, Federico
Gelsomino, Sandro
Lorusso, Roberto
Maessen, Jos
Lohese, Opema
Pacini, Davide
Suarez, Sofia Martin
Botta, Luca
Zimpfer, Daniel
Schaefer, Anne-Kristin
Szalkiewicz, Philipp
Meyns, Bart
De Vos, Marie
Vercaemst, Leen
Karck, Matthias
Meyer, Anna L.
Holler, Ana J.
Jacquet-Lagrèze, Matthias
Obadia, Jean Francois
Fellahi, Jean Luc
Wang, Amy S.
Kalampokas, Nikolaos
Lichtenberg, Artur
Aubin, Hug
Huang, Chun-Cheng
et al.
Abstract
Objective To evaluate whether dual-lumen (DL) versus single-lumen (SL) pulmonary artery cannulation improves outcomes in patients with refractory right ventricular failure (RVF) supported with extracorporeal life support and to identify which patients benefit most. Methods We conducted a multicenter retrospective cohort study using the international PLACE registry (2000-2020). Adults undergoing pulmonary artery cannulation for isolated RVF were included. Outcomes were in-hospital and 30-day mortality, bleeding, thromboembolic events, continuous renal-replacement therapy, and length of stay. Propensity score weighting was applied to adjust for baseline differences. Prespecified analyses tested effect modification by hypoxemia, renal function, platelet count, cannulation site, and oxygenator use. Mediation and clustering were used to explore physiological pathways and phenotypes. Results Among 345 patients, DL cannulation was associated with lower postoperative lactate and creatinine and with fewer bleeding events. In weighted multivariable models, DL reduced the risk of bleeding and the composite of bleeding or thromboembolism (weighted odds ratio, 0.50; 95% CI 0.32-0.77; P = .0017 and weighted odds ratio, 0.57; 95% CI 0.39-0.84; P = .004). Hypoxemia significantly strengthened the survival benefit of DL, whereas cannulation site and oxygenator use did not modify outcomes. Mediation analyses indicated that the effect of DL on survival was indirect, operating through early improvement in perfusion and renal function. Unsupervised clustering identified distinct postoperative biochemical phenotypes with markedly different prognoses; DL was associated with a shift toward favorable profiles. Conclusions In extracorporeal life support for RVF, DL pulmonary artery cannulation improves outcomes primarily by enhancing early organ function and reducing complications. Patients with baseline hypoxemia appear to benefit most, supporting a physiology-guided approach to cannulation strategy. © 2026 The Author(s).
Subjects
causal mediation
dual-lumen cannulation
hypoxemia
right ventricular failure
venovenous ECMO
Publisher
Elsevier BV
Type
journal-article