| Objective:To summarize the perioperative experience of extracorporeal membrane oxygenation(ECMO)in patients with chronic thromboembolic pulmonary hypertension(CTEPH)undergoing pulmonary endarterectomy(PEA),and to analyze the factors affecting the efficacy.Methods:The clinical data of 8 patients receiving ECMO after PEA in Fuwai Hospital from April 1997 to December 2018 were retrospectively analyzed.To compare the clinical characteristics of surviving discharged patients(successfully weaning and surviving discharged)and non-surviving discharged patients(died after weaning or unsuccessfully weaning),and to evaluate the application effect of ECMO.Results:Of the 8 patients,4(50%)survived and discharged,4(50%)died in hospital,and the overall survival rate was 50%;hospitalization time:1 survived before 2013,4 died,3 cases survived after 2013,and no death;duration of disease,survival group(month):62.5(13.5,116.8),death group:96.0(54.0,129.0);2 in survival group were treated with PTT before operation,but none in death group;DHCA:4 in survival group and 2 in death group;intraoperative circulatory arrest time(minutes):61.5(43.5,87.0)in survival group and 25.0(0,50.0)in death group;post-operative ECMO assistance time(hours):147.0(77.0.211.0)in survival group and 126.0(24.8,252.0)in death group;post-operative persistent pulmonary hypertension:2 in survival group and 4 in death group;post-operative pulmonary hypertension crisis:1 in survival group,4 in death group;the length of hospitalization after operation(days):29.5(21.5,45.0)in the survival group,6(2,10.5)in the death group,P=0.021,with significant statistical difference.Follow-up results:The longest follow-up time was 10 years and the shortest follow-up time was 18 months.The quality of life,exercise tolerance and cardiac function of the 4 surviving discharged patients were improved significantly.CONCLUSION:ECMO has a good effect on the treatment of reperfusion lung injury,residual pulmonary hypertension and right heart failure in patients with CTEPH after PEA.It has a certain application value in the perioperative period of PEA.Heart failure is the final result for all kinds of heart diseases to develop to the late stage,such as coronary heart disease.If we do not intervene as soon as possible(stent implantation,coronary artery bypass surgery,etc.),it will develop to heart failure in the late stage.Once entering heart failure,the effect of conservative drug therapy will be limited by coronary patency and remodeling of low-functioning ventricular structure.Allogeneic heart transplantation is an effective surgical treatment for advanced heart failure,but its limitation is also obvious,that is,donor shortage.The emergence of ventricular assist devices fills this gap.In recent years,various kinds of ventricular assist devices have emerged in endlessly The representative products are HeartMate2,HeartMate3 and HeartWare.After decades of development,ventricular assist devices have made a qualitative leap in appearance,volume and performance,and the comprehensive management level after implantation has also been significantly improved.However,perioperative complications still need to be further resolved,including infection,bleeding,mechanical failure,stroke,right heart failure,aortic insufficiency and so on.This paper mainly reviews the development status of several mainstream models,and compares the mechanical characteristics and performance of the representative products HeartMate2 and HeartMate3 of axial flow pump and centrifugal pump.The common complications after operation were explained in detail,and the strategies of diagnosis and treatment were summarized. |
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