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DOI: 10.1055/s-0032-1332359
Veno-venous extra-corporeal membrane oxygenation implantation in a patient with left ventricular assist device
Introduction: Extracorporeal membrane oxygenation (ECMO) may be necessary to treat respiratory failure after left ventricular assist device (LVAD) implantation. We report a patient (pt) who underwent veno-venous ECMO (VV-ECMO) implantation for respiratory failure after LVAD implantation.
Aims: A 56 year old male pt with dilative cardiomyopathy was admitted to our department after undergoing successful cardiopulmonary reanimation. Few hours after admission, the pt was supported with femoro-femoral veno-arterial ECMO as a bridge to decision. Following 2 days of ECMO support, echocardiography showed severely dilated left ventricle with an ejection fraction of merely 15%. Ultimately, the pt underwent LVAD implantation. Intraoperatively, weaning from ECMO was initially successful with a good right ventricular function under moderate doses of inotropic support. However, severe hypoxia due to preexisting aspiration pneumonia was observed. Because of the good right ventricular function, a VV- ECMO (25 Fr Inflow Cannule in femoral vein and 18 Fr Outflow Cannule in right subclavian vein) (Figure 1) was implanted. The oxygenation improved immediately. However, following several hours of support, the oxygenation was deteriorated. Echocardiography examination showed worsening of the right ventricular function. Therefore, an emergent resternotomy and RVAD implantation with oxygenator (Inflow Cannule: right atrium through femoral vein, right subclavian vein; Outflow Cannule: graft was anastamosed to the pulmonary artery) was performed. The pt's condition immediately stabilized. The temporary RVAD with oxygenator was explanted after 7 days support and the pt was later discharged home in a good condition.
![](https://www.thieme-connect.de/media/thoracic/2013S01/op120.jpg)
Fig. 1
Discussion: This case showed that VV-ECMO in pts with LVAD may not achieve satisfactory oxygenation and cause delayed right ventricular failure due to volume overload of the right ventricle. We strongly recommend using RVAD with oxygenator in these pts.