Prophylactic Extracorporeal Life Support (ECLS) for Patients after Mitral and/or Tricuspid Valve Surgery in the Presence of Severe Chronic Right Heart Failure

Yasser Hegazy, Stefan Bauer, Noha Keshk, Despina Diamantis, Sherif Abd Elaziz, Ralf Sodian

Mediclin Heart Center Lahr, Lahr, Germany

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – A

Abstract

Background: Surgery of the atrioventricular valves in the presence of chronic right heart failure is associated with high risk for mortality. In order to improve the early and postoperative outcomes of these high risk patients we studied the effect of ventricular unloading using extracorporeal life support system (ECLS) before weaning the patients from cardiopulmonary bypass (CPB).

Methods:Five patients were prospectively included in the study. All the patients had severe chronic right heart failure and underwent mitral and/or tricuspid valve surgery in 2016. Prophylactic intraoperative ventricular unloading was achieved using femoral veno-arterial ECLS. This was planned for a minimum of 48 hours. With this concept it was possible to achieve a smooth weaning from CPB on a low dose of Catecholamines and consecutive chest closure in all patients. For an effective ventricular unloading, the ECLS flow ranged from 2-2.5 liters/minute and weaning was controlled by echocardiography.

Results: The patients had a mean age of 73.4 years, 3 were males, mean logistic EUROScore was 29.93, mean TAPSE was 14.6. Mean duration on ECLS was 63 hours, and the mean ICU stay was 11.6 days. All the patients could be weaned successfully from ECLS, with only one in-hospital mortality seven days after weaning due to toxic bullous pemphigoid. The other 4 patients could be successfully discharged from our clinic. At 1-year follow up, all discharged patients are still alive and well. One patient showed moderate to severe tricuspid valve regurgitation and severe pulmonary artery hypertension (systolic pulmonary pressure 71 mmHg) after tricuspid valve repair and ECLS support.

Conclusions: Our preliminary study shows a positive outcome in these high-risk patients suggesting that the new concept of prophylactic effective ventricular unloading improves the safety of mitral and/or tricuspid valve surgery in the presence of severe chronic right heart failure.