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Hoeper MM. Extracorporeal Life Support in Pulmonary Hypertension: Practical Aspects. Semin Respir Crit Care Med 2023; 44:771-776. [PMID: 37709284 DOI: 10.1055/s-0043-1772752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Extracorporeal life support (ECLS), in particular veno-arterial extracorporeal membrane oxygenation, has emerged as a potentially life-saving treatment modality in patients presenting with pulmonary hypertension and right heart failure refractory to conventional treatment. Used mainly as a bridge to lung transplantation, ECLS is also being used occasionally as a bridge to recovery in patients with treatable causes of right heart failure. This review article describes indications, contraindications, techniques, and outcomes of the use of ECLS in patients with PH, focusing on practical aspects in the management of such patients.
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Affiliation(s)
- Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- German Center for Lung Research (DZL), Member of the European Reference Network on Rare Pulmonary Diseases (ERN-LUNG), Hannover, Germany
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Stącel T, Latos M, Urlik M, Nęcki M, Antończyk R, Hrapkowicz T, Kurzyna M, Ochman M. Interventional and Surgical Treatments for Pulmonary Arterial Hypertension. J Clin Med 2021; 10:jcm10153326. [PMID: 34362109 PMCID: PMC8348951 DOI: 10.3390/jcm10153326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/20/2021] [Accepted: 07/27/2021] [Indexed: 12/13/2022] Open
Abstract
Despite significant advancements in pharmacological treatment, interventional and surgical options are still viable treatments for patients with pulmonary arterial hypertension (PAH), particularly idiopathic PAH. Herein, we review the interventional and surgical treatments for PAH. Atrial septostomy and the Potts shunt can be useful bridging tools for lung transplantation (Ltx), which remains the final surgical treatment among patients who are refractory to any other kind of therapy. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) remains the ultimate bridging therapy for patients with severe PAH. More importantly, VA-ECMO plays a crucial role during Ltx and provides necessary left ventricular conditioning during the initial postoperative period. Pulmonary denervation may potentially be a new way to ensure better transplant-free survival among patients with the aforementioned disease. However, high-quality randomized controlled trials are needed. As established, obtaining the Eisenmenger physiology among patients with severe pulmonary hypertension by creating artificial defects is associated with improved survival. However, right-to-left shunting may be harmful after Ltx. Closure of the artificially created defects may carry some risk associated with cardiac surgery, especially among patients with Potts shunts. In conclusion, PAH requires an interdisciplinary approach using pharmacological, interventional, and surgical modalities.
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Affiliation(s)
- Tomasz Stącel
- Silesian Centre for Heart Diseases in Zabrze, Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, 40-055 Katowice, Poland; (M.L.); (M.U.); (M.N.); (R.A.); (T.H.)
- Correspondence: (T.S.); (M.O.); Tel.: +48-691-045-785 (T.S.); +48-60-923-4437 (M.O.)
| | - Magdalena Latos
- Silesian Centre for Heart Diseases in Zabrze, Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, 40-055 Katowice, Poland; (M.L.); (M.U.); (M.N.); (R.A.); (T.H.)
| | - Maciej Urlik
- Silesian Centre for Heart Diseases in Zabrze, Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, 40-055 Katowice, Poland; (M.L.); (M.U.); (M.N.); (R.A.); (T.H.)
| | - Mirosław Nęcki
- Silesian Centre for Heart Diseases in Zabrze, Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, 40-055 Katowice, Poland; (M.L.); (M.U.); (M.N.); (R.A.); (T.H.)
| | - Remigiusz Antończyk
- Silesian Centre for Heart Diseases in Zabrze, Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, 40-055 Katowice, Poland; (M.L.); (M.U.); (M.N.); (R.A.); (T.H.)
| | - Tomasz Hrapkowicz
- Silesian Centre for Heart Diseases in Zabrze, Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, 40-055 Katowice, Poland; (M.L.); (M.U.); (M.N.); (R.A.); (T.H.)
| | - Marcin Kurzyna
- European Health Centre Otwock, Centre of Postgraduate Medical Education, Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, 05-400 Otwock, Poland;
| | - Marek Ochman
- Silesian Centre for Heart Diseases in Zabrze, Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, 40-055 Katowice, Poland; (M.L.); (M.U.); (M.N.); (R.A.); (T.H.)
- Correspondence: (T.S.); (M.O.); Tel.: +48-691-045-785 (T.S.); +48-60-923-4437 (M.O.)
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Hill GED, Traudt RJ, Durham LA, Pagel PS, Tawil JN. Successful Treatment of Refractory Status Asthmaticus Accompanied by Right Ventricular Dysfunction Using a Protek Duo Tandem Heart Device. J Cardiothorac Vasc Anesth 2019; 33:3085-3089. [PMID: 31076305 DOI: 10.1053/j.jvca.2019.03.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Graham E D Hill
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Ryan J Traudt
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Lucian A Durham
- Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Paul S Pagel
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
| | - Justin N Tawil
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
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Becher T, Baumann S, Eder F, Fastner C, Behnes M, Loßnitzer D, Dösch C, Borggrefe M. Peripheral Ventricular Assist Devices in Interventional Cardiology: The Impella® Micro-Axial Pump. Interv Cardiol 2017. [DOI: 10.5772/67883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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