From the *Division of Pediatric Cardiology, Department of Pediatrics, Columbia University, College of Physicians and Surgeons, New York, New York; †Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York; and ‡Division of Cardiothoracic Surgery, Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, New York.
ASAIO J. 2014 Jan-Feb;60(1):129-33. doi: 10.1097/MAT.0000000000000021.
Patients with group 1 pulmonary arterial hypertension (PAH) and decompensated right heart failure (RHF) were not previously considered for extracorporeal membrane oxygenation (ECMO) as bridge to transplantation (BTT) or bridge to recovery (BTR) because options were limited by long transplantation wait times and perceived inability to wean ECMO. In a retrospective review, we describe our center's multidisciplinary mechanical-medical approach to ECMO as a bridging therapy for PAH (2009-2012). Suitability for ECMO was determined using a defined algorithm. Six patients (age, 32 ± 11 years) underwent mechanical-medical bridging. Two transplant-eligible patients underwent successful BTT. The four patients ineligible for transplantation underwent BTR with escalation of targeted medical therapies before weaning off ECMO. Three of four BTR patients survived to ECMO decannulation (duration, 12 ± 7; range, 7-23 days). In this single-institution experience, mechanical-medical BTT and BTR with ECMO and targeted PAH therapies were used as a novel treatment strategy to successfully manage acute RHF in PAH.
1 组肺动脉高压（PAH）和失代偿性右心衰竭（RHF）患者以前不考虑体外膜肺氧合（ECMO）作为移植桥接（BTT）或恢复桥接（BTR），因为选择受到长移植等待时间和认为无法脱机 ECMO 的限制。在回顾性研究中，我们描述了我们中心使用机械-药物联合 ECMO 作为 PAH 桥接治疗的多学科方法（2009-2012 年）。使用定义的算法确定 ECMO 的适用性。6 名患者（年龄 32±11 岁）接受机械-药物桥接。2 名适合移植的患者成功进行了 BTT。4 名不符合移植条件的患者在脱机 ECMO 前进行了目标药物治疗的 BTR。4 名 BTR 患者中有 3 名在 ECMO 拔管时存活（持续时间 12±7；范围 7-23 天）。在这单中心经验中，机械-药物 BTT 和 BTR 联合 ECMO 和靶向 PAH 治疗被用作一种新的治疗策略，成功治疗了 PAH 的急性 RHF。
