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Central conversion from peripheral extracorporeal life support for patients with refractory congestive heart failure

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Abstract

Conversion from peripheral extracorporeal life support (ECLS) to the central one can improve and stabilize hemodynamics in patients with refractory congestive heart failure-related multiorgan failure, whereas indication and selection of the type of the central ECLS have not been fully established. Institutional outcome of the conversion therapy was herein reviewed to verify indication and selection of three types of central ECLS. This study enrolled an institutional consecutive surgical series of 24 patients with refractory congestive heart failure under peripheral ECLS, related to fulminant myocarditis (n = 15), dilated cardiomyopathy (n = 5), or acute myocardial infarction (n = 4). They were converted to central Y-extracorporeal membrane oxygenation (ECMO, n = 6), extracorporeal ventricular assist device (EC-VAD, n = 12), or pump catheter (n = 6), dependent upon the degree of multiorgan failure. Despite the different degree of multiorgan failure prior to the conversion, improvement in end-organ perfusion and reduction in right atrial and pulmonary artery pressure were promptly achieved regardless of the type of the central ECLS. There were five in-hospital mortalities (21%) during the central ECLS, whereas mechanical support was weaned-off in 11 cases (46%) and durable LVAD was subsequently implanted for bridge to transplantation in eight cases (33%). Conversion from the peripheral ECLS to the central ones, such as central Y-ECMO, EC-VAD or pump catheter, promptly established a sufficient support with heart and lung unloading in patients with refractory congestive heart failure.

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Authors and Affiliations

  1. Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibeshimmachi, Suita, Osaka, 565-8565, Japan

    Satsuki Fukushima, Naoki Tadokoro, Ayumi Koga, Yusuke Shimahara, Shin Yajima, Takashi Kakuta, Junjiro Kobayashi & Tomoyuki Fujita

  2. Department of Cardiovascular Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan

    Ayumi Koga

  3. Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan

    Kensuke Kuroda, Seiko Nakajima, Takuya Watanabe, Masanobu Yanase & Norihide Fukushima

Authors
  1. Satsuki Fukushima
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  2. Naoki Tadokoro
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  3. Ayumi Koga
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  4. Yusuke Shimahara
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  5. Shin Yajima
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  6. Takashi Kakuta
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  7. Kensuke Kuroda
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  8. Seiko Nakajima
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  9. Takuya Watanabe
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  11. Norihide Fukushima
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  12. Junjiro Kobayashi
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  13. Tomoyuki Fujita
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Correspondence to Satsuki Fukushima.

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Fukushima, S., Tadokoro, N., Koga, A. et al. Central conversion from peripheral extracorporeal life support for patients with refractory congestive heart failure. J Artif Organs 23, 214–224 (2020). https://doi.org/10.1007/s10047-020-01157-0

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  • DOI: https://doi.org/10.1007/s10047-020-01157-0

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