Central conversion from peripheral extracorporeal life support for patients with refractory congestive heart failure
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ORIGINAL ARTICLE Cardiopulmonary Bypass
Central conversion from peripheral extracorporeal life support for patients with refractory congestive heart failure Satsuki Fukushima1 · Naoki Tadokoro1 · Ayumi Koga1,2 · Yusuke Shimahara1 · Shin Yajima1 · Takashi Kakuta1 · Kensuke Kuroda3 · Seiko Nakajima3 · Takuya Watanabe3 · Masanobu Yanase3 · Norihide Fukushima3 · Junjiro Kobayashi1 · Tomoyuki Fujita1 Received: 24 September 2019 / Accepted: 27 January 2020 © The Japanese Society for Artificial Organs 2020
Abstract Conversion from peripheral extracorporeal life support (ECLS) to the central one can improve and stabilize hemodynamics in patients with refractory congestive heart failure-related multiorgan failure, whereas indication and selection of the type of the central ECLS have not been fully established. Institutional outcome of the conversion therapy was herein reviewed to verify indication and selection of three types of central ECLS. This study enrolled an institutional consecutive surgical series of 24 patients with refractory congestive heart failure under peripheral ECLS, related to fulminant myocarditis (n = 15), dilated cardiomyopathy (n = 5), or acute myocardial infarction (n = 4). They were converted to central Y-extracorporeal membrane oxygenation (ECMO, n = 6), extracorporeal ventricular assist device (EC-VAD, n = 12), or pump catheter (n = 6), dependent upon the degree of multiorgan failure. Despite the different degree of multiorgan failure prior to the conversion, improvement in end-organ perfusion and reduction in right atrial and pulmonary artery pressure were promptly achieved regardless of the type of the central ECLS. There were five in-hospital mortalities (21%) during the central ECLS, whereas mechanical support was weaned-off in 11 cases (46%) and durable LVAD was subsequently implanted for bridge to transplantation in eight cases (33%). Conversion from the peripheral ECLS to the central ones, such as central Y-ECMO, EC-VAD or pump catheter, promptly established a sufficient support with heart and lung unloading in patients with refractory congestive heart failure. Keywords Refractory congestive heart failure · Extracorporeal life support · Central conversion
Introduction Peripheral extracorporeal life support (ECLS) by femoral artery/vein cannulations that are connected to centrifugal pump and oxygenator has been established for cases having a sudden onset of refractory congestive heart failure related to a variety of causes [1, 2]. Quick launch in the * Satsuki Fukushima [email protected] 1
Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, 6‑1 Kishibeshimmachi, Suita, Osaka 565‑8565, Japan
2
Department of Cardiovascular Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
3
Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan
bedside is a distinguishing feature of the peripheral ECLS, whereas prolonged peripheral ECLS in cases with delayed cardiac functional recovery induces a c
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