Oxy Right Ventricular Assist Device Using Extracoporeal Membrane Oxygenation as a Bridge to Lung Transplant for Right Ventricular Failure

Abstract

Patients with IPF and cardiopulmonary failure caused by secondary pulmonary hypertension have poor prognoses. If lung oxygen exchange capacity is completely lost and secondary heart failure caused by pulmonary exacerbation was appeared, it is difficult to maintain survival via conventional peripheral ECMO alone. We used Oxy-RVAD(RA-PA ECMO) as novel configuration delivered via anterior thoracotomy to treat end-stage IPF patients with RHF. Patients with RHF caused by secondary pulmonary hypertension, who had a bridge to LT, were indicated for Oxy-RVAD placement. After ECMO initiation, echoic findings were used to diagnose RHF, and Oxy-RVAD was inserted when the hemodynamic status was unstable or laboratory data on other organs were abnormal. We chose the cannulation and Oxy-RVAD incision sites (left fourth anterior thoracotomy) considering the fact that LT was planned. Two purse-string sutures were placed more than 1 cm above the pulmonary valve to allow return cannula insertion using the Seldinger technique. After MPA cannulation, the inflow cannula in the jugular vein was converted into a drainage cannula. To decompress the right heart, double drainage was enforced. A total of eleven patients underwent conversion from peripheral ECMO to Oxy-RVAD between September 2018 and September 2019. Eight patients successfully underwent LT. The remaining three patients survived for 9, 14 and 23 days under Oxy-RVAD, respectively. Hospital stay of all patients was 73.0 ± 55.4. 30 days mortality and In hospital mortality in LT group was 0 and 2 (25%). In conclusion, Oxy-RVAD can be reduced the signs of multiple organ failures that can be caused by RVF by decompressing the right ventricle. In the successful lung transplant group that waited for lung transplant under RVAD, they had satisfactory survival result. Oxy-RVAD is useful option in Patients with RHF caused by secondary pulmonary hypertension, who were on ECMO support as a bridge to LT.