Useful central mechanical circulatory support system for critical biventricular heart failure associated with high pulmonary vascular resistance

IF 2.2 3区医学 Q3 ENGINEERING, BIOMEDICAL Artificial organs Pub Date : 2024-11-20 DOI:10.1111/aor.14906

Naoki Tadokoro, Satoshi Kainuma, Kohei Tonai, Tetsuya Koyamoto, Naonori Kawamoto, Takashi Kakuta, Kimito Minami, Hiroshi Nishioka, Yasumasa Tsukamoto, Satsuki Fukushima

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Abstract

Background

Peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) is a powerful life-saving tool; however, it can sometimes induce severe pulmonary edema in patients with critical heart failure. We report favorable outcomes in critically ill patients by using a central ECMO system with an innovative blood perfusion method.

Methods

We analyzed 10 patients with severe heart failure and pulmonary edema who were treated with the central ECMO system at our institution between April 2022 and October 2023. The system consists of central cannulation with two inflows from the right atrium and left ventricle, and two outflows to the aorta and pulmonary artery, connected by two Y-connectors to a single ECMO circuit (RALV-AOPA ECMO). In this system, blood flow to the pulmonary artery is adjusted and mean pulmonary artery pressure is limited to <20 mm Hg, which reduces right ventricular afterload and prevents the worsening of pulmonary edema and hemorrhage.

Results

Six patients were diagnosed with fulminant lymphocytic myocarditis, and four were diagnosed with coronavirus disease 2019-related myocardial injury. The ejection fraction was 6.5 ± 4.1%. The average intraoperative pulmonary vascular resistance was 4.6 ± 1.3 Wood units. After 24 h, the mean pulmonary arterial pressure was 12.8 ± 4.3 mm Hg, and pulmonary vascular resistance was 1.5 ± 0.3 Wood units. The duration of central RALV-AOPA ECMO was 3.7 ± 2.1 days. Finally, six patients were weaned, three received HeartMate3, and one received heart transplantation. At follow-up, all patients remained alive (428 ± 208 days), and two patients experienced cerebrovascular accidents without any lasting sequelae.

Conclusions

The central RALV-AOPA ECMO is an innovative system that achieves early improvement in pulmonary vascular resistance and is safe and feasible for patients with acute biventricular failure and pulmonary edema.

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用于治疗伴有高肺动脉阻力的重症双心室心衰的中央机械循环支持系统。

背景：外周静脉-动脉体外膜肺氧合（ECMO）是挽救生命的有力工具，但有时会诱发重症心衰患者出现严重肺水肿。我们报告了采用创新血液灌流方法的中心 ECMO 系统对重症患者的良好疗效：我们分析了 2022 年 4 月至 2023 年 10 月期间在我院接受中心 ECMO 系统治疗的 10 例严重心衰和肺水肿患者。该系统由中心插管组成，右心房和左心室有两个流入口，主动脉和肺动脉有两个流出口，通过两个 Y 型连接器连接到一个 ECMO 循环（RALV-AOPA ECMO）。在这一系统中，肺动脉的血流量得到调整，肺动脉平均压力被限制在结果范围内：六名患者被诊断为暴发性淋巴细胞性心肌炎，四名患者被诊断为冠状病毒病2019相关性心肌损伤。射血分数为 6.5 ± 4.1%。术中平均肺血管阻力为4.6±1.3伍德单位。24 小时后，平均肺动脉压为 12.8 ± 4.3 mm Hg，肺血管阻力为 1.5 ± 0.3 Wood 单位。中心 RALV-AOPA ECMO 的持续时间为 3.7 ± 2.1 天。最后，六名患者断血，三名患者接受了 HeartMate3，一名患者接受了心脏移植。在随访中，所有患者仍然存活（428 ± 208 天），两名患者发生了脑血管意外，但没有留下任何后遗症：中央 RALV-AOPA ECMO 是一种创新系统，可及早改善肺血管阻力，对急性双心室衰竭和肺水肿患者安全可行。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Artificial organs 工程技术-工程：生物医学

CiteScore

4.30

自引率

12.50%

发文量

303

审稿时长

4-8 weeks

期刊介绍： Artificial Organs is the official peer reviewed journal of The International Federation for Artificial Organs (Members of the Federation are: The American Society for Artificial Internal Organs, The European Society for Artificial Organs, and The Japanese Society for Artificial Organs), The International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, The International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation. Artificial Organs publishes original research articles dealing with developments in artificial organs applications and treatment modalities and their clinical applications worldwide. Membership in the Societies listed above is not a prerequisite for publication. Articles are published without charge to the author except for color figures and excess page charges as noted.