Possibilities and limitations of a miniaturized long-term extracorporeal life support system as bridge to transplantation in a case with biventricular heart failure

Abstract

In cardiac surgery extracorporeal life support systems (ECLS), also known as extracorporeal membrane oxygenation systems (ECMO), are often placed in case of postcardiotomy shock, until the patient's myocardial pump function recovers. Patients under ECLS are typically intubated and immobilized. We present a 57-year-old man suffering from severe ischemic cardiomyopathy in biventricular failure and intractable cardiogenic shock, who was supported with a miniaturized cardiopulmonary bypass system (MECC((R))) installed as venoarterial ECLS for 37 days. The patient was fully awake, spontaneously breathing, and practicing exercise in bed during life support for four weeks. He then required intubation for pneumonia, but later underwent successful transplantation. In conclusion, this case demonstrates that ECLS with miniaturized heart-lung machines offer the possibility of prolonged and safe support, ideal as a bridge to decision in patients with cardiogenic shock. On the other side, this report also indicates that ECLS is not recommended as a bridge to transplantation on a routine basis.