Extracorporeal life support and left ventricular unloading in a non-intubated patient as bridge to heart transplantation

Int J Artif Organs. 2013 Dec;36(12):913-6. doi: 10.5301/ijao.5000251. Epub 2013 Oct 2.

Abstract

Introduction: Veno-arterial extracorporeal life support (ECLS) is a well-established bridging therapy in patients with cardiac or pulmonary failure to maintain organ function and is frequently performed in patients who are not intubated. However, severly impaired cardiac function can occur pulmonary edemy in these patients, necessitating left ventricular unloading.

Methods and results: In this study we report a 37-year old female patient with familiar dilated cardiomyopathy suffering from acute biventricular heart failure. After implantation of a peripheral ECLS, the decreased ventricular led to refractory pulmonary edema. To unload the left ventricle, an percutaneous balloon atrioseptostomy was performed without intubating the patient. The left ventricle was vented by the venous cannula resting inside the atrioseptostomy. After twelve days on ECLS, the patient underwent orthotopic heart transplantation. The postoperative course was uneventful and the patient discharged from intensive care unit four days after surgery.

Conclusions: In this report we present a patient in which the hybrid technique of ECLS with secondary left ventricular unloading was successfully used as a bridge to transplant therapy. This procedure may offer an alternative bridge-to-decision options in selected patients, including those that were not intubated or anaesthetized.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Cardiomyopathy, Dilated / complications
  • Decompression, Surgical*
  • Extracorporeal Membrane Oxygenation* / adverse effects
  • Female
  • Heart Failure / diagnosis
  • Heart Failure / etiology
  • Heart Failure / physiopathology
  • Heart Failure / surgery*
  • Heart Transplantation*
  • Humans
  • Pulmonary Edema / etiology
  • Pulmonary Edema / physiopathology
  • Pulmonary Edema / surgery
  • Severity of Illness Index
  • Stroke Volume
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Ventricular Function, Left*

Supplementary concepts

  • Familial dilated cardiomyopathy