Venovenous Extracorporeal Life Support After Pulmonary Endarterectomy: Indications, Techniques, and Outcomes

Pulmonary endarterectomy is the accepted therapy for thromboembolic pulmonary hypertension. A recognized complication of this surgery is the postoperative development of reperfusion edema, a potentially fatal cause of respiratory failure. Because reperfusion edema can be a reversible process, tempor...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:The Annals of thoracic surgery 2006-12, Vol.82 (6), p.2139-2145
Hauptverfasser: Thistlethwaite, Patricia A., Madani, Michael M., Kemp, Aaron D., Hartley, Mary, Auger, William R., Jamieson, Stuart W.
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 2145
container_issue 6
container_start_page 2139
container_title The Annals of thoracic surgery
container_volume 82
creator Thistlethwaite, Patricia A.
Madani, Michael M.
Kemp, Aaron D.
Hartley, Mary
Auger, William R.
Jamieson, Stuart W.
description Pulmonary endarterectomy is the accepted therapy for thromboembolic pulmonary hypertension. A recognized complication of this surgery is the postoperative development of reperfusion edema, a potentially fatal cause of respiratory failure. Because reperfusion edema can be a reversible process, temporizing support measures may be life saving. We retrospectively reviewed our experience with venovenous extracorporeal life support (V-V ECLS) from July 1990 to February 2006, in 20 adult patients (mean age 50.5 ± 14.5 years) presenting with potentially reversible respiratory failure after pulmonary endarterectomy. This subset of patients comprised 1.12% of our total pulmonary endarterectomy experience during that time (1,790 cases). Overall in-hospital survival was 30.0% for patients requiring ECLS support after pulmonary endarterectomy versus 94.2% for patients who underwent pulmonary endarterectomy alone during the same timeframe. V-V ECLS was instituted at a mean of 86.8 hours after surgery. The mean duration of V-V ECLS was 123.4 ± 71.3 hours. The most common cause of death in ECLS patients after pulmonary endarterectomy was pulmonary hemorrhage. Survival was greater in patients cannulated within 120 hours of surgery (46.2% survival; 6 of 13 patients) compared with those cannulated after 120 hours (0 of 7 patients). Multiple logistic regression identified long duration of mechanical ventilation pre-ECLS and severity of preoperative pulmonary hypertension together as predictors of mortality. A small subset of patients undergoing pulmonary endarterectomy develop temporary life-threatening respiratory failure secondary to severe reperfusion edema. In those patients with satisfactory hemodynamic outcome, V-V ECLS is a therapeutic option when all other conventional strategies have been exhausted.
doi_str_mv 10.1016/j.athoracsur.2006.07.020
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_68184569</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0003497506013725</els_id><sourcerecordid>68184569</sourcerecordid><originalsourceid>FETCH-LOGICAL-c438t-57aca22ef44500a9620f44cc1ed31e90c66c6ab8b7183b9031aeeb1f83431cf3</originalsourceid><addsrcrecordid>eNqFkMFu1DAQhi0EotvCKyBf4ESC7cROwq1UW6i0UpFYcbWcyUT1KrEX26no2-NoV9ojB8sz9j8z_3yEUM5Kzrj6cihNevLBQFxCKRhTJWtKJtgrsuFSikIJ2b0mG8ZYVdRdI6_IdYyHnIr8_ZZc8YYLxYXckOk3Ov-czxLp9m_KLX04-oBmojs7Iv21HHOa6O2YMNCfyzR7Z8IL3brBhPyEkPz88pU-uMGCSda7-JnuEZ6c_bNgjo0b6OOSwM8Y35E3o5kivj_fN2R_v93f_Sh2j98f7m53BdRVmwrZGDBC4FjXkjHTKcFyCMBxqDh2DJQCZfq2b3hb9R2ruEHs-dhWdcVhrG7Ip1PbY_CriaRnGwGnyTjMe2rV8raWqsvC9iSE4GMMOOpjsHNeT3OmV9D6oC-g9Qpas0Zn0Ln0w3nG0s84XArPZLPg41lgIphpDMaBjRddNiubbvXw7aTDDOTZYtARLDrAwa5w9eDt_938Axq9o6M</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>68184569</pqid></control><display><type>article</type><title>Venovenous Extracorporeal Life Support After Pulmonary Endarterectomy: Indications, Techniques, and Outcomes</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Thistlethwaite, Patricia A. ; Madani, Michael M. ; Kemp, Aaron D. ; Hartley, Mary ; Auger, William R. ; Jamieson, Stuart W.</creator><creatorcontrib>Thistlethwaite, Patricia A. ; Madani, Michael M. ; Kemp, Aaron D. ; Hartley, Mary ; Auger, William R. ; Jamieson, Stuart W.</creatorcontrib><description>Pulmonary endarterectomy is the accepted therapy for thromboembolic pulmonary hypertension. A recognized complication of this surgery is the postoperative development of reperfusion edema, a potentially fatal cause of respiratory failure. Because reperfusion edema can be a reversible process, temporizing support measures may be life saving. We retrospectively reviewed our experience with venovenous extracorporeal life support (V-V ECLS) from July 1990 to February 2006, in 20 adult patients (mean age 50.5 ± 14.5 years) presenting with potentially reversible respiratory failure after pulmonary endarterectomy. This subset of patients comprised 1.12% of our total pulmonary endarterectomy experience during that time (1,790 cases). Overall in-hospital survival was 30.0% for patients requiring ECLS support after pulmonary endarterectomy versus 94.2% for patients who underwent pulmonary endarterectomy alone during the same timeframe. V-V ECLS was instituted at a mean of 86.8 hours after surgery. The mean duration of V-V ECLS was 123.4 ± 71.3 hours. The most common cause of death in ECLS patients after pulmonary endarterectomy was pulmonary hemorrhage. Survival was greater in patients cannulated within 120 hours of surgery (46.2% survival; 6 of 13 patients) compared with those cannulated after 120 hours (0 of 7 patients). Multiple logistic regression identified long duration of mechanical ventilation pre-ECLS and severity of preoperative pulmonary hypertension together as predictors of mortality. A small subset of patients undergoing pulmonary endarterectomy develop temporary life-threatening respiratory failure secondary to severe reperfusion edema. In those patients with satisfactory hemodynamic outcome, V-V ECLS is a therapeutic option when all other conventional strategies have been exhausted.</description><identifier>ISSN: 0003-4975</identifier><identifier>EISSN: 1552-6259</identifier><identifier>DOI: 10.1016/j.athoracsur.2006.07.020</identifier><identifier>PMID: 17126125</identifier><identifier>CODEN: ATHSAK</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Endarterectomy - adverse effects ; Extracorporeal Circulation - methods ; Female ; Humans ; Hypertension, Pulmonary - etiology ; Hypertension, Pulmonary - surgery ; Male ; Medical sciences ; Middle Aged ; Pulmonary Artery - surgery ; Pulmonary Edema - etiology ; Pulmonary Edema - therapy ; Pulmonary Embolism - complications ; Pulmonary Embolism - surgery ; Reperfusion Injury - etiology ; Reperfusion Injury - therapy ; Retrospective Studies ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Surgery of the respiratory system ; Treatment Outcome</subject><ispartof>The Annals of thoracic surgery, 2006-12, Vol.82 (6), p.2139-2145</ispartof><rights>2006 The Society of Thoracic Surgeons</rights><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-57aca22ef44500a9620f44cc1ed31e90c66c6ab8b7183b9031aeeb1f83431cf3</citedby><cites>FETCH-LOGICAL-c438t-57aca22ef44500a9620f44cc1ed31e90c66c6ab8b7183b9031aeeb1f83431cf3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=18345799$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17126125$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Thistlethwaite, Patricia A.</creatorcontrib><creatorcontrib>Madani, Michael M.</creatorcontrib><creatorcontrib>Kemp, Aaron D.</creatorcontrib><creatorcontrib>Hartley, Mary</creatorcontrib><creatorcontrib>Auger, William R.</creatorcontrib><creatorcontrib>Jamieson, Stuart W.</creatorcontrib><title>Venovenous Extracorporeal Life Support After Pulmonary Endarterectomy: Indications, Techniques, and Outcomes</title><title>The Annals of thoracic surgery</title><addtitle>Ann Thorac Surg</addtitle><description>Pulmonary endarterectomy is the accepted therapy for thromboembolic pulmonary hypertension. A recognized complication of this surgery is the postoperative development of reperfusion edema, a potentially fatal cause of respiratory failure. Because reperfusion edema can be a reversible process, temporizing support measures may be life saving. We retrospectively reviewed our experience with venovenous extracorporeal life support (V-V ECLS) from July 1990 to February 2006, in 20 adult patients (mean age 50.5 ± 14.5 years) presenting with potentially reversible respiratory failure after pulmonary endarterectomy. This subset of patients comprised 1.12% of our total pulmonary endarterectomy experience during that time (1,790 cases). Overall in-hospital survival was 30.0% for patients requiring ECLS support after pulmonary endarterectomy versus 94.2% for patients who underwent pulmonary endarterectomy alone during the same timeframe. V-V ECLS was instituted at a mean of 86.8 hours after surgery. The mean duration of V-V ECLS was 123.4 ± 71.3 hours. The most common cause of death in ECLS patients after pulmonary endarterectomy was pulmonary hemorrhage. Survival was greater in patients cannulated within 120 hours of surgery (46.2% survival; 6 of 13 patients) compared with those cannulated after 120 hours (0 of 7 patients). Multiple logistic regression identified long duration of mechanical ventilation pre-ECLS and severity of preoperative pulmonary hypertension together as predictors of mortality. A small subset of patients undergoing pulmonary endarterectomy develop temporary life-threatening respiratory failure secondary to severe reperfusion edema. In those patients with satisfactory hemodynamic outcome, V-V ECLS is a therapeutic option when all other conventional strategies have been exhausted.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Endarterectomy - adverse effects</subject><subject>Extracorporeal Circulation - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Hypertension, Pulmonary - etiology</subject><subject>Hypertension, Pulmonary - surgery</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pulmonary Artery - surgery</subject><subject>Pulmonary Edema - etiology</subject><subject>Pulmonary Edema - therapy</subject><subject>Pulmonary Embolism - complications</subject><subject>Pulmonary Embolism - surgery</subject><subject>Reperfusion Injury - etiology</subject><subject>Reperfusion Injury - therapy</subject><subject>Retrospective Studies</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Surgery of the respiratory system</subject><subject>Treatment Outcome</subject><issn>0003-4975</issn><issn>1552-6259</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkMFu1DAQhi0EotvCKyBf4ESC7cROwq1UW6i0UpFYcbWcyUT1KrEX26no2-NoV9ojB8sz9j8z_3yEUM5Kzrj6cihNevLBQFxCKRhTJWtKJtgrsuFSikIJ2b0mG8ZYVdRdI6_IdYyHnIr8_ZZc8YYLxYXckOk3Ov-czxLp9m_KLX04-oBmojs7Iv21HHOa6O2YMNCfyzR7Z8IL3brBhPyEkPz88pU-uMGCSda7-JnuEZ6c_bNgjo0b6OOSwM8Y35E3o5kivj_fN2R_v93f_Sh2j98f7m53BdRVmwrZGDBC4FjXkjHTKcFyCMBxqDh2DJQCZfq2b3hb9R2ruEHs-dhWdcVhrG7Ip1PbY_CriaRnGwGnyTjMe2rV8raWqsvC9iSE4GMMOOpjsHNeT3OmV9D6oC-g9Qpas0Zn0Ln0w3nG0s84XArPZLPg41lgIphpDMaBjRddNiubbvXw7aTDDOTZYtARLDrAwa5w9eDt_938Axq9o6M</recordid><startdate>20061201</startdate><enddate>20061201</enddate><creator>Thistlethwaite, Patricia A.</creator><creator>Madani, Michael M.</creator><creator>Kemp, Aaron D.</creator><creator>Hartley, Mary</creator><creator>Auger, William R.</creator><creator>Jamieson, Stuart W.</creator><general>Elsevier Inc</general><general>Elsevier Science</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20061201</creationdate><title>Venovenous Extracorporeal Life Support After Pulmonary Endarterectomy: Indications, Techniques, and Outcomes</title><author>Thistlethwaite, Patricia A. ; Madani, Michael M. ; Kemp, Aaron D. ; Hartley, Mary ; Auger, William R. ; Jamieson, Stuart W.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-57aca22ef44500a9620f44cc1ed31e90c66c6ab8b7183b9031aeeb1f83431cf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Endarterectomy - adverse effects</topic><topic>Extracorporeal Circulation - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Hypertension, Pulmonary - etiology</topic><topic>Hypertension, Pulmonary - surgery</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pulmonary Artery - surgery</topic><topic>Pulmonary Edema - etiology</topic><topic>Pulmonary Edema - therapy</topic><topic>Pulmonary Embolism - complications</topic><topic>Pulmonary Embolism - surgery</topic><topic>Reperfusion Injury - etiology</topic><topic>Reperfusion Injury - therapy</topic><topic>Retrospective Studies</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Surgery of the respiratory system</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Thistlethwaite, Patricia A.</creatorcontrib><creatorcontrib>Madani, Michael M.</creatorcontrib><creatorcontrib>Kemp, Aaron D.</creatorcontrib><creatorcontrib>Hartley, Mary</creatorcontrib><creatorcontrib>Auger, William R.</creatorcontrib><creatorcontrib>Jamieson, Stuart W.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Annals of thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Thistlethwaite, Patricia A.</au><au>Madani, Michael M.</au><au>Kemp, Aaron D.</au><au>Hartley, Mary</au><au>Auger, William R.</au><au>Jamieson, Stuart W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Venovenous Extracorporeal Life Support After Pulmonary Endarterectomy: Indications, Techniques, and Outcomes</atitle><jtitle>The Annals of thoracic surgery</jtitle><addtitle>Ann Thorac Surg</addtitle><date>2006-12-01</date><risdate>2006</risdate><volume>82</volume><issue>6</issue><spage>2139</spage><epage>2145</epage><pages>2139-2145</pages><issn>0003-4975</issn><eissn>1552-6259</eissn><coden>ATHSAK</coden><abstract>Pulmonary endarterectomy is the accepted therapy for thromboembolic pulmonary hypertension. A recognized complication of this surgery is the postoperative development of reperfusion edema, a potentially fatal cause of respiratory failure. Because reperfusion edema can be a reversible process, temporizing support measures may be life saving. We retrospectively reviewed our experience with venovenous extracorporeal life support (V-V ECLS) from July 1990 to February 2006, in 20 adult patients (mean age 50.5 ± 14.5 years) presenting with potentially reversible respiratory failure after pulmonary endarterectomy. This subset of patients comprised 1.12% of our total pulmonary endarterectomy experience during that time (1,790 cases). Overall in-hospital survival was 30.0% for patients requiring ECLS support after pulmonary endarterectomy versus 94.2% for patients who underwent pulmonary endarterectomy alone during the same timeframe. V-V ECLS was instituted at a mean of 86.8 hours after surgery. The mean duration of V-V ECLS was 123.4 ± 71.3 hours. The most common cause of death in ECLS patients after pulmonary endarterectomy was pulmonary hemorrhage. Survival was greater in patients cannulated within 120 hours of surgery (46.2% survival; 6 of 13 patients) compared with those cannulated after 120 hours (0 of 7 patients). Multiple logistic regression identified long duration of mechanical ventilation pre-ECLS and severity of preoperative pulmonary hypertension together as predictors of mortality. A small subset of patients undergoing pulmonary endarterectomy develop temporary life-threatening respiratory failure secondary to severe reperfusion edema. In those patients with satisfactory hemodynamic outcome, V-V ECLS is a therapeutic option when all other conventional strategies have been exhausted.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>17126125</pmid><doi>10.1016/j.athoracsur.2006.07.020</doi><tpages>7</tpages></addata></record>
fulltext fulltext
identifier ISSN: 0003-4975
ispartof The Annals of thoracic surgery, 2006-12, Vol.82 (6), p.2139-2145
issn 0003-4975
1552-6259
language eng
recordid cdi_proquest_miscellaneous_68184569
source MEDLINE; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection
subjects Adult
Aged
Biological and medical sciences
Endarterectomy - adverse effects
Extracorporeal Circulation - methods
Female
Humans
Hypertension, Pulmonary - etiology
Hypertension, Pulmonary - surgery
Male
Medical sciences
Middle Aged
Pulmonary Artery - surgery
Pulmonary Edema - etiology
Pulmonary Edema - therapy
Pulmonary Embolism - complications
Pulmonary Embolism - surgery
Reperfusion Injury - etiology
Reperfusion Injury - therapy
Retrospective Studies
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the heart
Surgery of the respiratory system
Treatment Outcome
title Venovenous Extracorporeal Life Support After Pulmonary Endarterectomy: Indications, Techniques, and Outcomes
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-23T17%3A02%3A09IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Venovenous%20Extracorporeal%20Life%20Support%20After%20Pulmonary%20Endarterectomy:%20Indications,%20Techniques,%20and%20Outcomes&rft.jtitle=The%20Annals%20of%20thoracic%20surgery&rft.au=Thistlethwaite,%20Patricia%20A.&rft.date=2006-12-01&rft.volume=82&rft.issue=6&rft.spage=2139&rft.epage=2145&rft.pages=2139-2145&rft.issn=0003-4975&rft.eissn=1552-6259&rft.coden=ATHSAK&rft_id=info:doi/10.1016/j.athoracsur.2006.07.020&rft_dat=%3Cproquest_cross%3E68184569%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=68184569&rft_id=info:pmid/17126125&rft_els_id=S0003497506013725&rfr_iscdi=true