Postcardiotomy right ventricular (RV) failure develops during the
perioperative period following pulmonary
hypertensive crisis or acute
myocardial infarction. This study reports our institutional experience in treating these patients with
extracorporeal life support (ECLS). Between June 2002 and July 2005, 46 adults were treated with ECLS for postcardiotomy
shock. Acute RV failure was the cause of support in 14 (30%). Patient mean age was 55.7 +/- 15.4 years. Cardiac pathologies were valvular (n = 7), coronary (n = 1), combined coronary and valvular disease (n = 2), complex congenital heart (n = 2),
aortic aneurysm (n = 1), and
cardiomyopathy post heart transplant (n = 1). The triggers of RV failure were
pulmonary hypertension (n = 6), RV
infarction (n = 4), and not defined (n = 4). Patients were supported on ECLS for a mean duration of 71 +/- 52 h (range, 10-183 h). Major complications included
acute renal failure requiring
hemodialysis (n = 4), reexploration for
bleeding (n = 2), and
acute subdural hematoma (n = 1). Nine (64%) patients were successfully weaned from ECLS, and seven (50%) survived to discharge. Preexisting
pulmonary hypertension had a favorable tendency for weaning, and
acute renal failure requiring
hemodialysis correlated with in-hospital mortality. ECLS is beneficial for treating postcardiotomy RV failure when conventional
therapy is exhausted. As it can be deployed rapidly and does not require resternotomy for weaning, ECLS could be regarded as the first choice of mechanical support for postcardiotomy RV failure.