A Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation (pVAECMO) for Short-Term Mechanical Circulatory Support in Heart Transplant Candidates

Vitaly Poptsov, Ekatherina Spirina, Nadezda Koloskova, Sergey Uhrenkov, Anastasiya Dogonasheva , Elnur Aliev, Vladislav Voronkov, Sergey Masutin, Stanislav Ustin, Valeriy Hatutsky

Federal State Budgetary Institution “Academician V.I.Shumakov Federal Research Center of Transplantology and Artificial Organs”, Ministry of Health of the Russian Federation, Moscow, Russian Federation, Moscow, Russia

Date, time and location: 2018.05.27 10:30, Congress Hall, 2F–A

Abstract

Introduction. pVAECMO is one of methods of temporary mechanical circulatory support (MCS) prior heart transplantation (HT).

Aim of this study was own experience ofperipheral VA ECMO for MCS at heart transplant candidates needed in urgent HT.

Materials and methods. This study included 125 pts (107 (86%) men and 18 (14%) women, age from 12 to 72 (43±1.2) yrs) treated with a peripheral VA-ECMO system installed within the period from 01.01.2011 – 31.12.2016. The indication for the start of its use was rapidly progressing congestive heart failure (CHF) of level 1 or 2 by the INTERMACS scale.

Results. The peripheral cannulation was used to perform VA ECMO in 100% (n=125). During VA ECMO extracorporeal blood flow rate ranged from 2.2 to 4.5 (3.2±0.4 l/min) or 1.6±0.2 l/min/m². 113 (90.4%) of 125 potential recipients underwent HT. The duration of VA ECMO prior to HT (n=113) was from 8 hours to 40 (7.1±2.7) days.During of VA ECMO, 12 (9.6%) of 125potential recipients (11 male and 1 female, age from 21 to 63 (40±4)) died. In 2 (16.7%) of 12 cases the cause of death was brain death associated with a thromboembolic cerebrovascular event. The majority of patients (n=10, 83.3%) died from progressive multiorgan failure and sepsis. Six of twelve patients presented unilateral (n=2) or bilateral (n=4) pneumonia.

Conclusion. Peripheral VA ECMO provides a successful bridge to HT in 90% of heart transplant candidates who needed pretransplant MCS. Beginning of VA ECMO before the development of pronounced hemodynamic, multiorgan and metabolic disorders creates the conditions for a successful MCS and subsequent HT.