Oxy-right Ventricular Assist Device for Bridging of Right Heart Failure to Lung Transplantation
Sung Kwang Lee, Do Hyung Kim, Woo Hyun Cho, Hye Ju Yeo
Abstract
BACKGROUND: Right heart failure develops in lung transplantation candidates on extracorporeal membrane oxygenation (ECMO) support and increases mortality. The safety and feasibility of the oxy-right ventricular assist device (oxyRVAD) as a bridge to lung transplantation in severe right heart failure caused by terminal lung disease have not been evaluated. METHODS: We retrospectively reviewed 14 patients who used oxyRVAD for bridging of right heart failure to lung transplantation. RESULTS: The major cause of lung transplantation was acute exacerbation of interstitial lung disease (78.6%), and the median venovenous ECMO duration was 7 d. Before oxyRVAD, median mean pulmonary artery pressure was 60.5 mm Hg (interquartile range [IQR], 54-68), and the median peak tricuspid regurgitation velocity was 3.9 m/s (IQR, 3.7-4.1). After oxyRVAD conversion, median mean pulmonary artery pressure was 60.5 mm Hg (IQR, 57.3-65), and the median peak tricuspid regurgitation velocity was 2.9 (IQR, 2.6-3.2). All patients were hemodynamically stable (median arterial blood pressure, 83 mm Hg; median heart rate, 79 bpm). Three patients developed pulmonary congestion (21.4%), and all patients stabilized within 24 h. Active rehabilitation during ECMO was possible in all patients, and the median duration of awake state during ECMO was 14 d. A total of 10 patients were bridged successfully to lung transplantation, and hospital survival rates were 90%. CONCLUSIONS: OxyRVAD stabilized hemodynamic parameters without fatal complications, permitted the discontinuation of sedation, and allowed active rehabilitation in patients with severe right heart failure. OxyRVAD may be a feasible option for bridging of right heart failure to lung transplantation.