Oxy-right Ventricular Assist Device for Bridging of Right Heart Failure to Lung Transplantation.

Abstract

BACKGROUND:

Right heart failure develops in lung transplantation candidates on extracorporeal membrane oxygenation (ECMO) support and increases mortality. The safety and feasibility of the oxy-right ventricular assist device (oxyRVAD) as a bridge to lung transplantation in severe right heart failure caused by terminal lung disease have not been evaluated.

METHODS:

We retrospectively reviewed 14 patients who used oxyRVAD for bridging of right heart failure to lung transplantation.

RESULTS:

The major cause of lung transplantation was acute exacerbation of interstitial lung disease (78.6%), and the median venovenous ECMO duration was 7 d. Before oxyRVAD, median mean pulmonary artery pressure was 60.5 mm Hg (interquartile range [IQR], 54-68), and the median peak tricuspid regurgitation velocity was 3.9 m/s (IQR, 3.7-4.1). After oxyRVAD conversion, median mean pulmonary artery pressure was 60.5 mm Hg (IQR, 57.3-65), and the median peak tricuspid regurgitation velocity was 2.9 (IQR, 2.6-3.2). All patients were hemodynamically stable (median arterial blood pressure, 83 mm Hg; median heart rate, 79 bpm). Three patients developed pulmonary congestion (21.4%), and all patients stabilized within 24 h. Active rehabilitation during ECMO was possible in all patients, and the median duration of awake state during ECMO was 14 d. A total of 10 patients were bridged successfully to lung transplantation, and hospital survival rates were 90%.

CONCLUSIONS:

OxyRVAD stabilized hemodynamic parameters without fatal complications, permitted the discontinuation of sedation, and allowed active rehabilitation in patients with severe right heart failure. OxyRVAD may be a feasible option for bridging of right heart failure to lung transplantation.

• Authors: Sung Kwang Lee, Do Hyung Kim, Woo Hyun Cho, Hye Ju Yeo
• Journal: Transplantation (Transplantation) Vol. 105 Issue 7 Pg. 1610-1614 (07 01 2021) ISSN: 1534-6080 [Electronic] United States
• PMID: 32947584 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Topics

• Aged
• Feasibility Studies
• Female
• Heart Failure (diagnosis, etiology, physiopathology, therapy)
• Heart-Assist Devices
• Humans
• Lung Diseases (complications, diagnosis, physiopathology, surgery)
• Lung Transplantation
• Male
• Middle Aged
• Prosthesis Design
• Prosthesis Implantation (adverse effects, instrumentation)
• Recovery of Function
• Retrospective Studies
• Severity of Illness Index
• Time Factors
• Treatment Outcome
• Ventricular Function, Right