Abstract
BackgroundRight ventricular heart failure (RVHF) is a critical complication in patients with respiratory failure particularly among those who transitioned to lung transplantation using veno-venous (V-V) extracorporeal membrane oxygenation (ECMO). In these patients, both cardiac and respiratory functions are supported using veno-arterial (V-A) or veno-arterial-venous (V-AV) ECMO. However, these modalities increase the risk of device-related complications, such as thromboembolism, bleeding, and limb ischemia, and they may disturb early rehabilitation. Due to these limitations, a right ventricular assist device with an oxygenator (Oxy-RVAD) using ECMO may be considered for patients with RVHF with V-V ECMO.MethodsThe study included patients who underwent Oxy-RVAD using ECMO due to RVHF while on V-V ECMO as a bridge to lung transplantation (BTT) due to severe respiratory failure. The patients were enrolled at a tertiary care, university hospital between 2018 and 2020.ResultsEight patients underwent Oxy-RVAD using ECMO due to RVHF for BTT. Seven patients were bridged successfully to lung transplantation. One patient died prior to transplantation from complications of interstitial lung disease. There were no major ECMO-related complications during the Oxy-RVAD using ECMO period in any patient. For those patients who were successfully bridged, the average duration of V-V ECMO was 10 days and Oxy-RVAD using ECMO was 12 days. All patients with BTT were discharged with a 30-day survival rate of 100% (7/7 patients). The 180-day survival rate was 85% (6/7 patients).ConclusionsThis study suggests that Oxy-RVAD using ECMO may be a viable option for bridging patients with RVHF to lung transplantation.
Contemporary outcome of unplanned right ventricular assist device for severe right heart failure after continuous-flow left ventricular assist device insertion
