Korean J Crit Care Med.  2015 Nov;30(4):295-298. 10.4266/kjccm.2015.30.4.295.

Extracorporeal Membrane Oxygenation for 67 Days as a Bridge to Heart Transplantation in a Postcardiotomy Patient with Failing Heart and Mediastinitis

Affiliations
  • 1Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. pwpark@skku.edu

Abstract

We report a case of successful heart transplantation after 67 days of support with venoarterial extracorporeal membrane oxygenation (ECMO) in a patient who underwent surgery for type A aortic dissection and myocardial infarction complicated by irreversible myocardial damage and a deep sternal wound infection. During ECMO support, left heart vent and distal limb perfusion were performed. Mediastinitis was treated with mediastinal washout and irrigation. Multiple complications from peripheral ECMO were successfully managed.

Keyword

cardiomyopathy; extracorporeal membrane oxygenation; heart; mediastinitis; shock; transplantation

MeSH Terms

Cardiomyopathies
Extracorporeal Membrane Oxygenation*
Extremities
Heart Transplantation*
Heart*
Humans
Mediastinitis*
Myocardial Infarction
Perfusion
Shock
Transplantation
Wound Infection

Figure

  • Fig. 1. Left ventricular vent catheter inserted via right anterior thoracotomy (arrow).

  • Fig. 2. Chest radiographs that were obtained before (A), immediately after (B), and two days after (C) vent cannula insertion. Pulmonary edema had resolved in (C).

  • Fig. 3. Summary of key events during ECMO support. ECMO: extracorporeal membrane oxygenator; CAG: coronary angiography; CPR: cardiopulmonary resuscitation; CABG: coronary artery bypass grafting; TPL: transplantation; CC: circuit (oxygenator & pump) change; HC: head (centrifugal pump) change; LV: left ventricle.


Reference

References

1. Francis GS, Greenberg BH, Hsu DT, Jaski BE, Jessup M, LeWinter MM, et al. ACCF/AHA/ACP/HFSA/ISHLT 2010 clinical competence statement on management of patients with advanced heart failure and cardiac transplant: a report of the ACCF/AHA/ACP Task Force on Clinical Competence and Training. J Am Coll Cardiol. 2010; 56:424–53.
2. Barth E, Durand M, Heylbroeck C, Rossi-Blancher M, Boignard A, Vanzetto G, et al. Extracorporeal life support as a bridge to high-urgency heart transplantation. Clin Transplant. 2012; 26:484–8.
Article
3. Cho YH, Yang JH, Sung K, Jeong DS, Park PW, Kim WS, et al. Extracorporeal life support as a bridge to heart transplantation: importance of organ failure in recipient selection. ASAIO J. 2015; 61:139–43.
4. Aubron C, Cheng A, Pilcher D, Leong T, Magrin G, Cooper DJ, et al. Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: a 5-year cohort study. Crit Care. 2013; 17:R73.
Article
5. Guttendorf J, Boujoukos AJ, Ren D, Rosenzweig MQ, Hravnak M. Discharge outcome in adults treated with extracorporeal membrane oxygenation. Am J Crit Care. 2014; 23:365–77.
Article
Full Text Links
  • KJCCM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr