Department of Anesthesiology and Perioperative Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
Ann Card Anaesth. 2024 Oct 1;27(4):349-351. doi: 10.4103/aca.aca_18_24. Epub 2024 Aug 28.
Over the previous 20 years, the use of extracorporeal membranous oxygenation (ECMO) as a bridge to durable left ventricular assist device (dLVAD) increased significantly. Additionally, emerging literature has demonstrated a protective effect of biventricular decompression while on ECMO, with one such strategy including a temporary LVAD and right ventricular assist device (RVAD). The complexity of these operations is increased by the frequency of re-sternotomies, which result in adhesions and difficult access to traditional cannulation sites. In this case report, we present a patient presenting for a re-sternotomy for dLVAD on biventricular support in whom the RVAD outflow cannula was spliced into the cardiopulmonary bypass venous reservoir by the cardiac anesthesiologist. This innovative cannulation strategy allowed for continuation of RVAD flows to prevent thrombosis and active venting of the pulmonary artery to facilitate a bloodless surgical field.
在过去的 20 年中，体外膜氧合（ECMO）作为持久左心室辅助装置（dLVAD）的桥接手段的使用显著增加。此外，新出现的文献表明，在 ECMO 期间双心室减压具有保护作用，其中一种策略包括临时左心室辅助装置和右心室辅助装置（RVAD）。由于频繁的再次开胸手术，这些操作的复杂性增加，导致粘连和难以接近传统的插管部位。在本病例报告中，我们介绍了一位患者，该患者因双心室支持的 dLVAD 而再次开胸，心脏麻醉师将 RVAD 流出管拼接在体外循环静脉储液器中。这种创新的插管策略允许继续 RVAD 流量以防止血栓形成，并积极排空肺动脉以促进无血手术区域。
