Right ventricular assist device with an oxygenator using extracorporeal membrane oxygenation as a bridge to lung transplantation in a patient with severe respiratory failure and right heart decompensation

Abstract

Right heart decompensation is a fatal complication in patients with respiratory failure, particularly in those transitioned to lung transplantation using veno-venous extracorporeal membrane oxygenation (V-V ECMO). In these patients, veno-arterial (V-A ECMO) or veno-arterialvenous extracorporeal membrane oxygenation (V-AV ECMO) is used to support both cardiac and respiratory function. However, these processes may increase the risk of device-related complications such as bleeding, thromboembolism, and limb ischemia. In the present case, a 64-year-old male patient with idiopathic pulmonary fibrosis developed respiratory failure and commenced treatment with V-V ECMO as a bridge to lung transplantation. Unfortunately, the patient developed right heart decompensation and required both cardiac and respiratory support during treatment with V-V ECMO. Instead of adding arterial cannulation, he was switched to a novel configuration, a right ventricular assist device with an oxygenator (Oxy- RVAD) using ECMO, with drainage cannulation from the femoral vein and return cannulation to the main pulmonary artery. The patient was successfully bridged to lung transplantation without serious complications after 10 days of Oxy-RVAD support. To the best of our knowledge, this is an extreme rare and challenging case of Oxy-RVAD using ECMO in a patient successfully bridged to lung transplantation.

Keywords: extracorporeal membrane oxygenation; heart failure; heart-assist devices; lung transplantation; respiratory insufficiency; right heart bypass.

Figure 1.

Chest radiographs showing initial position of drainage and return cannulae (A) and those after adjustment due to recirculation (B). Note that the increased distance between drainage and return cannulae after adjustment.

Figure 2.

A chest radiograph showing drainage cannula at right atrium (RA) and return cannula at main pulmonary artery (MPA) in right ventricular assist device with an oxygenator support.

Figure 3.

A clinical photograph showing end-to-side anastomosis of return cannula to main pulmonary artery in right ventricular assist device with an oxygenator support.