Extracorporeal Membrane Oxygenation as a Postoperative Left Ventricle Conditioning Tool After Lung Transplantation in Patients With Primary Pulmonary Artery Hypertension: First Polish Experience

Transplant Proc. 2020 Sep;52(7):2113-2117. doi: 10.1016/j.transproceed.2020.02.113. Epub 2020 Apr 2.

Abstract

Background: Primary pulmonary hypertension can lead to hypertrophy of the right ventricle and ultimately to its insufficiency. Lung transplantation remains the only viable treatment for patients with certain forms of this disease. Usage of extracorporeal membrane oxygenation in veno-arterial form (VA-ECMO) after transplantation is both protective for left ventricle (enables adaptation to increased blood flow) and right ventricle (provides time to return to appropriate dimensions and in some cases to correct tricuspid regurgitaion).

Case presentation: The case study describes 4 patients who were treated with VA-ECMO as a perioperative support. Three patients were diagnosed with idiopathic form of precapillary primary pulmonary hypertension. A fourth patient was a 49-year old woman diagnosed with hypoplastic pulmonary veins representing the postcapillary form of pulmonary hypertension. In all of the cases, VA-ECMO was introduced during the surgery (femoral vein/internal jugular vein and femoral artery) and maintained for several days after the transplantation. Regular echocardiographic and biochemical assessment in postoperative course revealed that cardiac function improved during and after such treatment among all patients. They were successfully weaned off ECMO and finally surgically explanted without any local complications. One patient was treated with awake ECMO protocol.

Conclusions: VA-ECMO was proved to be a useful tool during the transplantation and postoperative period. It helps to restore proper cardiac function, as well as prevent adverse effects of aforementioned pathologic changes of a heart.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Extracorporeal Membrane Oxygenation / methods*
  • Familial Primary Pulmonary Hypertension / complications*
  • Familial Primary Pulmonary Hypertension / surgery
  • Female
  • Heart Diseases / etiology*
  • Heart Diseases / therapy*
  • Heart Ventricles / physiopathology
  • Humans
  • Lung Transplantation*
  • Male
  • Middle Aged
  • Poland
  • Pulmonary Artery / physiopathology
  • Young Adult