Saeed Diyar, Maxhera Bujar, Westenfeld Ralf, Lichtenberg Artur, Albert Alexander
Clinic for Cardiovascular Surgery, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
Artif Organs. 2015 Aug;39(8):719-23. doi: 10.1111/aor.12490. Epub 2015 Apr 24.
Central veno-arterial extracorporeal membrane oxygenation (ECMO) is traditionally implanted using direct cannulation of the aorta and right atrium. We aim to summarize the outcome of patients who underwent perioperative central ECMO implantation using an alternative surgical approach, which allows sternum closure and does not require resternotomy at the time of explantation. We retrospectively reviewed patients who required veno-arterial ECMO support at our institution between January 2013 and July 2014. Inclusion criteria were patients undergoing central ECMO implantation using the above-mentioned implantation technique. Nine patients (65 ± 14 years) were supported using this technique. Four patients underwent coronary bypass surgery as a primary surgery and the other five patients had combined coronary and valve surgeries. The average duration of ECMO support was 9 ± 7 days (range 1-24 days). The dominant postoperative complication was renal failure, which occurred in eight patients (89%). In four patients (44%), the ECMO was successfully removed. Survival rate to discharge was 22%. In conclusion, this study showed the feasibility of this alternative ECMO implantation technique. No technical issues were encountered. Extended support duration and reducing resternotomy risks may be the main advantages of this technique compared with conventional ECMO implantation methods.
传统上，中心静脉 - 动脉体外膜肺氧合（ECMO）是通过直接插管主动脉和右心房来植入的。我们旨在总结采用另一种手术方法进行围手术期中心ECMO植入的患者的结果，该方法允许关闭胸骨，并且在拔除ECMO时不需要再次开胸。我们回顾性分析了2013年1月至2014年7月在我们机构需要静脉 - 动脉ECMO支持的患者。纳入标准是采用上述植入技术进行中心ECMO植入的患者。9例患者（65±14岁）采用该技术进行支持。4例患者以冠状动脉搭桥手术作为初次手术，另外5例患者接受了冠状动脉和瓣膜联合手术。ECMO支持的平均持续时间为9±7天（范围1 - 24天）。主要的术后并发症是肾衰竭，8例患者（89%）发生该并发症。4例患者（44%）成功拔除了ECMO。出院生存率为22%。总之，本研究显示了这种替代ECMO植入技术的可行性。未遇到技术问题。与传统的ECMO植入方法相比，延长支持时间和降低再次开胸风险可能是该技术的主要优点。
