期刊
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
卷 155, 期 2, 页码 643-649出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.jtcvs.2017.09.045
关键词
CTEPH; pulmonary endarterectomy; ECMO; endobronchial hemorrhage
资金
- Actelion
- Bayer
- Pfizer
- GSK
- Merck
- Novartis
- Takeda Pharmaceuticals
- Eli Lilly
- Bellerophon
- Pulse Technologies
- MSD
- BTG
- Mundipharma
- OMT
- Roche
- United Therapeutics
Objectives: Pulmonary endarterectomy (PEA) is the only curative treatment option for patients with chronic thromboembolic pulmonary hypertension. Massive endobronchial bleeding that precludes weaning from cardiopulmonary bypass is an often-fatal complication of PEA. The aim of this study was to determine whether short-term extracorporeal membrane oxygenation (ECMO) is a safe and feasible procedure in patients with severe endobronchial bleeding. Methods: From January 2014 to December 2016, 396 patients (mean age 60 +/- 18 years, 54.5% male) underwent PEA in our department. Patients with severe endobronchial hemorrhage at the time of weaning from cardiopulmonary bypass (CPB) were switched to a heparin-coated venoarterial ECMO circuit. After full-dose protamine administration to restore normal coagulation, weaning from ECMO was attempted in the operating room. Results: In-hospital mortality was 2.3% (9/396 patients). Eight patients (2.0%) developed severe endobronchial bleeding classified as diffuse (n = 6) or localized (n = 2) by bronchoscopy. After reinstitution of CPB and subsequent switch to ECMO, the mean duration of ECMO support was 49 +/- 13 minutes, and all 8 patients were weaned successfully from ECMO in the operating theater without further signs of endobronchial bleeding. One patient needed venovenous ECMO support for poor oxygenation 6 hours after surgery. Seven patients were discharged after a prolonged postoperative stay of 17.6 +/- 4.1 days. One patient died. This new concept significantly reduced mortality compared with previous (2009-2013) ECMO support (P =.0406). Conclusions: For patients with massive endobronchial bleeding after PEA, the intraoperative switch from CPB to venoarterial ECMO support with full-dose protamine administration is a new and potentially life-saving treatment concept.
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