Extra Corporeal Membrane Oxygenation as Right Heart Support Following Left Ventricular Assist Device Placement: A New Cannulation Technique

Abstract

Extracorporeal membrane oxygenation is an established treatment for acute respiratory failure, or low cardiac output syndrome. This can be veno-venous, in which de-oxygenated blood is drained from the venous system and oxygenated before being returned to the venous system, and veno-arterial where the re-oxygenated venous blood is returned to the arterial system. Haemorrhage, sepsis and thrombo-embolism are common and potentially lethal complications. Left ventricular assist devices are a continually evolving technology, that may be used as a bridge to transplantation or destination therapy in end-stage cardiac failure. The VentrAssist™ left ventricular assist device is a small implantable, continuous flow centrifugal pump, that is controlled and powered by a percutaneous lead. However, in these patients, right heart failure may present as an acute event following weaning from cardiopulmonary bypass (CPB), or post-operatively in the intensive care unit. Patients who do not respond to inotropes and pulmonary vasodilators may need a right ventricular assist device (RVAD). We report a successful case of right heart assist extra corporeal membrane oxygenation used as temporary right heart support in combination with a VentrAssist™ left ventricular assist device. The use of right heart assist extra corporeal membrane oxygenation to help a failing right heart during left ventricular assist device placement is not new, however, our technique describes a novel method of cannulation of the femoral vein and pulmonary trunk via a tunnelled vascular tube graft, which allows the chest to be closed whilst on right heart support, and decannulation to proceed without resternotomy. This technique has also been used successfully subsequent to this.