Abstract
PURPOSE: Severe right heart failure (RHF) is a known complication of pulmonary hypertension, which increases mortality before lung transplantation. The safety and feasibility of venovenous (VV)-extracorporeal oxygenation (ECMO) using ProtekDuo(TM) (CardiacAssist Inc., Pittsburgh, PA) as a bridge to lung transplantation in severe RHF caused have not been well studied. This study aimed to evaluate the safety and feasibility of VV-ECMO using ProtekDuo(TM) as a bridge to lung transplantation in patients with severe RHF. METHODS: This study was a prospective review of the institutional lung transplantation database from June 2020 to June 2022. Patients who underwent lung transplantation with VV-ECMO using ProtekDuo(TM) for COVID-19 associated acute respiratory distress syndrome (ARDS) were prospectively enrolled; and preoperative and postoperative transthoracic echocardiographic (TTE) data were analyzed. RV function and size were evaluated and scored. The Wilcoxon signed-rank test was used to compare pre- and post-operative TTE values. RESULTS: During the study period, 20 patients underwent lung transplantation for COVID-19-associated ARDS with preoperative VV-ECMO using ProtekDuo(TM). TTE was assessed at a median of 15 days preoperatively (IQR, 7.75-31) and 155.5 days postoperatively (IQR, 112-210). Pre and post-operative median RVSP was 45.4 mm Hg (IQR, 29.4-49.0) and 30.0 mm Hg (IQR, 28.0-35.0), p=0.02, and the median mitral valve A was 0.70 cm/s (IQR, 0.70-0.80) and 0.55 cm/s (IQR, 0.50-0.70), p=0.03 (Table1). All patients were hemodynamically stable with active rehabilitation and did not require inotropes or inhaled nitric oxide. CONCLUSION: VV-ECMO with ProtekDuo(TM) for patients with COVID-19-associated ARDS before lung transplantation can stabilize patients without significant complications and allows active rehabilitation of patients with severe RHF.