Single center experience with patients on veno arterial ECMO due to postcardiotomy right ventricular failure.
postcardiotomy
right ventricular failure
va ECMO
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Jan 2020
Jan 2020
Historique:
pubmed:
7
11
2019
medline:
8
8
2020
entrez:
7
11
2019
Statut:
ppublish
Résumé
Right ventricular (RV) failure is associated with poor outcome and increased mortality in cardiac surgery. Aim of our study was to analyze the outcome of veno arterial extracorporeal membrane oxygenation (va ECMO) therapy in patients with isolated RV failure in postcardiotomy cardiogenic shock (PCS) and to evaluate risk factors associated with 30-day-mortality. Between August 2006 until August 2016, 64 consecutive patients with va ECMO therapy due to fulminant RV failure in PCS were identified and included in this retrospective observation. Further, outcome data and a comparison of va ECMO survivors and nonsurvivors was conducted. The mean age of the patient cohort was 63 ± 14 years. Patients were treated with va ECMO for 79 ± 61 hours. Twenty-eight patients (44%) were successfully weaned off ECMO support. Overall 30-day-mortality was 88% (56/64). Hemoglobin concentration before ECMO implantation, maximum rise of muscle-brain type creatine kinase during ECMO therapy, as well as lactic acid concentration 24 hours after initiation of va ECMO therapy were predictive for 30-day mortality. ECMO therapy in RV failure due to PCS is shown to be associated with an excessive mortality. Regarding our data, va ECMO might only be an appropriate short-term mechanical assist device separating patients form cardiopulmonary bypass with an acceptable weaning rate. Particularly, in case of failed hemodynamic recovery of the right heart on va ECMO, direct RV bypass systems might function as a bailout option. Additionally, cardiac enzymes and lactic acid might provide valuable information in meeting therapy-related decisions.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
83-88Informations de copyright
© 2019 Wiley Periodicals, Inc.
Références
Zehender M, Kasper W, Kauder E, et al. Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med. 1993;328:981-988.
Jacobs AK, Leopold JA, Bates E, et al. Cardiogenic shock caused by right ventricular infarction: a report from the SHOCK registry. J Am Coll Cardiol. 2003;41:1273-1279.
Krabatsch T, Hennig E, Stepanenko A, et al. Evaluation of the HeartWare HVAD centrifugal pump for right ventricular assistance in an in vitro model. ASAIO J. 2011;57:183-187.
Bermudez CA, Lagazzi L, Crespo MM. Prolonged support using a percutaneous oxyRVAD in a patient with end-stage lung disease, pulmonary hypertension, and right cardiac failure. ASAIO J. 2016;62:e37-e40.
Aggarwal V, Einhorn BN, Cohen HA. Current status of percutaneous right ventricular assist devices: first-in-man use of a novel dual lumen cannula. Catheter Cardiovasc Interv. 2016;88:390-396.
Truby L, Mundy L, Kalesan B, et al. Contemporary outcomes of venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock at a large tertiary care center. ASAIO J. 2015;61:403-409.
Ghodsizad A, Koerner MM, Brehm CE, El-Banayosy A. The role of extracorporeal membrane oxygenation circulatory support in the 'crash and burn' patient: from implantation to weaning. Curr Opin Cardiol. 2014;29:275-280.
Napp LC, Kuhn C, Hoeper MM, et al. Cannulation strategies for percutaneous extracorporeal membrane oxygenation in adults. Clin Res Cardiol. 2016;105:283-96.
Carroll BJ, Shah RV, Murthy V, et al. Clinical features and outcomes in adults with cardiogenic shock supported by extracorporeal membrane oxygenation. Am J Cardiol. 2015;116:1624-1630.
den Uil CA, Jewbali LS, Heeren MJ, Constantinescu AA, Van Mieghem NM, Reis Miranda DD. Isolated left ventricular failure is a predictor of poor outcome in patients receiving veno-arterial extracorporeal membrane oxygenation. Eur J Heart Fail. 2017;19(suppl 2):104-109.
Khorsandi M, Dougherty S, Bouamra O, et al. Extra-corporeal membrane oxygenation for refractory cardiogenic shock after adult cardiac surgery: a systematic review and meta-analysis. J Cardiothorac Surg. 2017;12:55.
Gronlykke L, Ravn HB, Gustafsson F, Hassager C, Kjaergaard J, Nilsson JC. Rightventricular dysfunction after cardiac surgery-diagnostic options. Scand Cardiovasc J. 2017;51:114-21.
Raina A, Vaidya A, Gertz ZM, Susan C, Forfia PR. Marked changes in right ventricular contractile pattern after cardiothoracic surgery: implications for postsurgical assessment of right ventricular function. J Heart Lung Transplant. 2013;32:777-83.
Breisblatt WM, Stein KL, Wolfe CJ, et al. Acute myocardial dysfunction and recovery: a common occurrence after coronary bypass surgery. J Am Coll Cardiol. 1990;15:1261-1269.
Diller GP, Wasan BS, Kyriacou A, et al. Effect of coronary artery bypass surgery on myocardial function as assessed by tissue Doppler echocardiography. Eur J Cardiothorac Surg. 2008;34:995-999.
Biancari F, Perrotti A, Dalen M, et al. Meta-analysis of the outcome after postcardiotomy venoarterial extracorporeal membrane oxygenation in adult patients. J Cardiothorac Vasc Anesth. 2018;32:1175-82.
Moazami N, Pasque MK, Moon MR, et al. Mechanical support for isolated right ventricular failure in patients after cardiotomy. J Heart Lung Transplant. 2004;23:1371-1375.
Cil C, Biteker FS, Celik O, Ozlek B, Ozlek E, Gokcek A. Right ventricle in severe sepsis and septic shock. J Crit Care. 2019;50:311.
Rich JB, Akins CW, Daggett WM Jr. Right ventricular failure following cardiopulmonary bypass: inadequate myocardial protection or incomplete revascularization? Ann Thorac Surg. 1988;45:693-694.
Ohmes LB, Di Franco A, Guy TS, et al. Incidence, risk factors, and prognostic impact of re-exploration for bleeding after cardiac surgery: a retrospective cohort study. Int J Surg. 2017;48:166-73.
Chen JM, Levin HR, Rose EA, et al. Experience with right ventricular assist devices for perioperative right-sided circulatory failure. Ann Thorac Surg. 1996;61:305-310.
Kapur NK, Esposito ML, Bader Y, et al. Mechanical circulatory support devices for acute right ventricular failure. Circulation. 2017;136:314-26.
Haddad F, Couture P, Tousignant C, Denault AY. The right ventricle in cardiac surgery, a perioperative perspective: II. Pathophysiology, clinical importance, and management. Anesth Analg. 2009;108:422-433.
Haddad F, Couture P, Tousignant C, Denault AY. The right ventricle in cardiac surgery, a perioperative perspective: I. Anatomy, physiology, and assessment. Anesth Analg. 2009;108:407-21.
Sertic F, Ali A. Acute-right-ventricular-failure post-cardiotomy: RVAD as a bridge to a successful recovery. J Surg Case Rep. 2018;2018:rjy140.
Osaki S, Edwards NM, Johnson MR, Kohmoto T. A novel use of the implantable ventricular assist device for isolated right heart failure. Interact Cardiovasc Thorac Surg. 2008;7:651-653.
Kirklin JK, Naftel DC, Pagani FD, et al. Seventh INTERMACS annual report: 15,000 patients and counting. J Heart Lung Transplant. 2015;34:1495-504.
Mulaikal TA, Bell LH, Li B, Wagener G, Takayama H. Isolated right ventricular mechanical support: outcomes and prognosis. ASAIO J. 2018;64:e20-e27.
Padmanabhan H, Siau K, Curtis J, et al. Preoperative anemia and outcomes in cardiovascular surgery: systematic review and meta-analysis. Ann Thorac Surg. 2019. https://doi.org/10.1016/j.athoracsur.2019.04.108 [published online ahead of print June 21, 2019].
Loforte A, Marinelli G, Musumeci F, et al. Extracorporeal membrane oxygenation support in refractory cardiogenic shock: treatment strategies and analysis of risk factors. Artif Organs. 2014;38:E129-E141.
Debaty G, Babaz V, Durand M, et al. Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis. Resuscitation. 2017;112:1-10.