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. 2024;30(1):24-00070.
doi: 10.5761/atcs.oa.24-00070.

Extracorporeal Mechanical Circulatory Support after Pulmonary Thromboendarterectomy: Experience of One Center

Brunella Bertazzo  1 , Alejandro Cicolini  1 , Martin Fanilla  2 , Liliana Favaloro  3 , Jorge Caneva  4 , Roberto R Favaloro  5
Affiliations

Extracorporeal Mechanical Circulatory Support after Pulmonary Thromboendarterectomy: Experience of One Center

Brunella Bertazzo et al. Ann Thorac Cardiovasc Surg. 2024.

Abstract

Purpose: Pulmonary thromboendarterectomy (PTE) is the treatment for patients with chronic thromboembolic disease. In the immediate postoperative period, some patients may still experience life-threatening complications such as reperfusion lung injury, airway bleeding, and persistent pulmonary hypertension with consequent right ventricular dysfunction. These issues may require support with extracorporeal membrane oxygenation (ECMO) as a bridge to recovery or lung transplantation. This study aims to analyze our series of PTEs that require ECMO.

Methods: A descriptive and retrospective analysis of all PTE performed at the Favaloro Foundation University Hospital was conducted between March 2013 and December 2023.

Results: A total of 42 patients underwent PTE with a median age of 47 years (interquartile range: 26-76). The incidence of patients with ECMO was 26.6%, of which 53.6% were veno-venous (VV) ECMO. Preoperatively, a low cardiac index (CI), high right and left filling pressures, and high total pulmonary vascular resistances (PVRs) were associated with ECMO with a statistically significant relationship. The hospital mortality was 11.9%, and the mortality in the ECMO group was 45.5%, with a statistically significant relationship. Veno-arterial ECMO has a worse prognosis than VV ECMO.

Conclusions: Preoperatively, a low CI, high right and left filling pressures, and high total PVRs were associated with ECMO after PTE.

Keywords: ECMO; chronic thromboembolic pulmonary hypertension; extracorporeal membrane oxygenation; pulmonary thromboendarterectomy.

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Figures

Fig. 1
Fig. 1. Preoperative variables associated with ECMO after pulmonary endarterectomy. RV: right ventricle; TPVR: total pulmonary vascular resistance; CI: cardiac index; RAP: right atrial pressure; PCWP: pulmonary capillary wedge pressure; ECMO: extracorporeal membrane oxygenation
Fig. 2
Fig. 2. Causes of ECMO assistance after pulmonary endarterectomy. ECMO: extracorporeal membrane oxygenation
Fig. 3
Fig. 3. Poor prognostic factors in the ECMO group. TPVR: total pulmonary vascular resistance; PH: pulmonary hypertension; mPAP: mean pulmonary artery pressure; ECMO: extracorporeal membrane oxygenation
See this image and copyright information in PMC

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