Percutaneous venopulmonary artery extracorporeal membrane oxygenation for right heart failure after left ventricular assist device insertion

Yashutosh Joshi; Marie-Cecile Bories; Nadia Aissaoui; Jean-Michel Grinda; Alain Bel; Christian Latremouille; Jérôme Jouan

doi:10.1093/icvts/ivab197

Percutaneous venopulmonary artery extracorporeal membrane oxygenation for right heart failure after left ventricular assist device insertion

Interact Cardiovasc Thorac Surg. 2021 Nov 22;33(6):978-985. doi: 10.1093/icvts/ivab197.

Authors

Yashutosh Joshi^{1

2

3}, Marie-Cecile Bories⁴, Nadia Aissaoui^{5

6}, Jean-Michel Grinda⁴, Alain Bel⁴, Christian Latremouille^{4

6}, Jérôme Jouan^{4

6}

Affiliations

¹ St Vincent's Hospital, Sydney, NSW, Australia.
² Western Sydney University, Blacktown Clinical School, Sydney, NSW, Australia.
³ St Vincent's Clinical School UNSW, Sydney, NSW, Australia.
⁴ Hôpital Européen Georges Pompidou, Département de Chirurgie Cardio-vasculaire, Assistance Publique Hôpitaux de Paris, Paris, France.
⁵ Hôpital Européen Georges Pompidou, Service de Réanimation médicale, Assistance Publique Hôpitaux de Paris, Paris, France.
⁶ Université Paris-Descartes, Paris, France.

Abstract

Objectives: Right ventricular failure after left ventricular assist device (LVAD) insertion is associated with significant mortality and morbidity. Mechanical support options include right ventricular assist devices, venoarterial extracorporeal membrane oxygenation (ECMO) and venopulmonary artery ECMO, the latter often involving central cannulation. We sought to evaluate the feasibility and early outcomes of a truly percutaneous venopulmonary artery (pVPA) ECMO strategy, with the potential advantage of bedside removal once weaned.

Methods: Data from a single tertiary centre were reviewed retrospectively from January 2014 to January 2019. During this time, 54 patients underwent LVAD insertion, with 19 requiring mechanical support for right ventricular failure. Among them, 10 patients received pVPA ECMO. Implantation of the pVPA ECMO was performed under transoesophageal echocardiography and fluoroscopy guidance, with an inflow cannula placed in the right atrium via the right femoral vein and an outflow cannula placed in the left pulmonary artery (PA) via the right internal jugular vein.

Results: Cannula insertion was 100% successful with no need for repositioning. Eight patients (80%) were able to be successfully weaned (at the bedside); 6 were discharged from the hospital and there were no cases of early sepsis, mediastinitis or thromboembolism. At follow-up, 5 patients had received transplants (50%), with 1 on LVAD support as destination therapy (10%). Survival was 60 ± 15% and 50 ± 16% at 6 and 12 months, respectively.

Conclusions: pVPA ECMO is 100% technically feasible and is an efficient method for temporary right ventricular support after LVAD insertion with the advantage of simple bedside removal and avoidance of a PA graft remnant in the chest cavity.

Keywords: Extracorporeal membrane oxygenation; Left ventricular assist device; Mechanical support; Right ventricular failure.

MeSH terms

Extracorporeal Membrane Oxygenation* / methods
Heart Failure* / complications
Heart Failure* / diagnostic imaging
Heart Failure* / therapy
Heart-Assist Devices* / adverse effects
Humans
Pulmonary Artery / diagnostic imaging
Retrospective Studies