Marinakis Sotirios, Ferrari Enrico, Delay Dominique, Tozzi Piergiorgio, Berdajs Denis, Niclauss Lars, Rolf Tanina, von Segesser Ludwig Karl
From the Cardiovascular Surgery, CHUV, Lausanne, Switzerland.
ASAIO J. 2014 May-Jun;60(3):348-50. doi: 10.1097/MAT.0000000000000072.
In extreme situations, such as hyperacute rejection of heart transplant or major heart trauma, heart preservation may not be possible. Our experimental team works on a project of peripheral extracorporeal membrane oxygenation (ECMO) support in acardia as a bridge to heart transplantation or artificial heart implantation. An ECMO support was established in five calves (58.6 ± 6.9 kg) by the transjugular insertion to the caval axis of a self-expanded cannula, with carotid artery return. After baseline measurements, ventricular fibrillation was induced, great arteries were clamped, heart was excised, and right and left atria remnants, containing pulmonary veins, were sutured together leaving an atrial septal defect over the caval axis cannula. Measurements of pump flow and arterial pressure were taken with the pulmonary artery clamped and anastomosed with the caval axis for a total of 6 hours. Pulmonary artery anastomosis to the caval axis provided an acceptable 6 hour hemodynamic stability, permitting a peripheral access ECMO support in extreme scenarios indicating a heart explantation.
