Thorac Cardiovasc Surg 2012; 60 - PP105
DOI: 10.1055/s-0031-1297752

Institutional experience with extracorporeal membrane oxygenation support for right ventricular failure after left ventricular assist device implantation

S Mahr 1, F Eskandary 1, J Horvath 2, R Gottardi 1, A Rajek 3, H Schima 4, G Laufer 1, G Wieselthaler 1, D Zimpfer 1
  • 1Medical University Vienna, Abteilung für Herzchirurgie, Wien, Austria
  • 2Medical University Vienna, Center for Physics and Biomedical Engineering, Wien, Austria
  • 3Medical University Vienna, Department of Anesthesiology, Wien, Austria
  • 4Medical University Vienna, Center for Medical Physics and Biomedical Engineering, Wien, Austria

Objectives: Right ventricular failure complicating left ventricular assist device implantation (LVAD) has a poor outcome. This study was designed to determine the success of extracorporeal membrane oxygenation support (ECMO) for the treatment of right ventricular failure after LVAD implantation.

Methods: From December 2008 to August 2011 13 patients (mean age 56yrs, male 92.3%) undergoing LVAD implantation at our department received an ECMO for therapy refractory right ventricular failure. In 11 patients the ECMO was implanted at the time of LVAD implantation due to inability to wean from CPB. In 2 patients the ECMO was implanted preoperatively for therapy refractory biventricular failure and continued postoperatively for right ventricular failure.

Results: After recovery of right ventricular function, the ECMO was successfully explanted in 10 of 13 patients (77%). Three patients (23%) expired while on ECMO support. Mean duration of ECMO support was 3 days. One patient died despite successful ECMO weaning as a consequence of non-device related sepsis. Interestingly, mortality was higher in those patients receiving the ECMO prior to LVAD implantation (50%), as compared to those receiving the ECMO after inability to wean from cardiopulmonary bypass (27%, p< .05). Overall in-hospital mortality was 30.7%.

Conclusion: ECMO facilitates recovery of right ventricular function after LVAD implantation complicated by perioperative right ventricular failure. Nevertheless, perioperative mortality remains high, especially in those patients receiving the ECMO preoperatively for biventricular support.