Images in Cardiothoracic Medicine and Surgery
Modified extracorporeal life support: The Harefield technique
Asian Cardiovascular & Thoracic Annals 2016, Vol. 24(3) 289 ß The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492314552299 aan.sagepub.com
Alexander Weymann, Andre Ru¨diger Simon and Aron-Frederik Popov
Extracorporeal life support is an indispensable therapy for the acute treatment of patients with
cardiogenic shock. A common problem observed during extracorporeal life support is the absence of left ventricular unloading, which frequently leads to pulmonary edema and left ventricular distension. We present our modified technique for postcardiotomy cardiogenic shock patients to facilitate myocardial recovery due to active unloading of the left ventricle (Figure 1). Declaration of conflicting interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
Figure 1. The arterial line and 2 venous cannulae are tunnelled toward the mediastinum. After full-dose heparinization, a tube graft (10 mm in diameter, Gore-Tex Stretch Vascular Graft; WL Gore, Livingston, Scotland) is anastomosed to the ascending aorta by applying an aortic side clamp and 4/0 polypropylene running sutures, in the expectation of a potential upgrade to long-term mechanical circulatory support (HeartWare) and better flow distribution compared to direct cannulation, without the risk of incorrect placement in the supraaortic vessels. The tunnelled arterial line is coupled via a tube connector (*) to the vascular graft after complete deairing, and secured with cable ties. The right atrium (RA) is cannulated for venous return with a tunnelled 28F venous cannula of adjustable conformation (Medtronic, Minneapolis, MN, USA). A tunnelled 24F venting cannula (Medtronic) is implanted through the right superior pulmonary vein into the left ventricle (LV), warranting complete left ventricular decompression, and connected to the extracorporeal life support inflow (venous drainage) using a Y-connector. After meticulous deairing confirmed by transesophageal echocardiography, the central extracorporeal life support is set at full flow. Arrows indicate the direction of blood flow.
Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK Corresponding author: Alexander Weymann, MD, Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Hill End Road, Harefield, Middlesex UB9 6JH, UK. Email: [email protected]
Downloaded from aan.sagepub.com at University of Otago Library on June 4, 2016
Modified extracorporeal life support: The Harefield technique
Asian Cardiovascular & Thoracic Annals 2016, Vol. 24(3) 289 ß The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492314552299 aan.sagepub.com
Alexander Weymann, Andre Ru¨diger Simon and Aron-Frederik Popov
Extracorporeal life support is an indispensable therapy for the acute treatment of patients with
cardiogenic shock. A common problem observed during extracorporeal life support is the absence of left ventricular unloading, which frequently leads to pulmonary edema and left ventricular distension. We present our modified technique for postcardiotomy cardiogenic shock patients to facilitate myocardial recovery due to active unloading of the left ventricle (Figure 1). Declaration of conflicting interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
Figure 1. The arterial line and 2 venous cannulae are tunnelled toward the mediastinum. After full-dose heparinization, a tube graft (10 mm in diameter, Gore-Tex Stretch Vascular Graft; WL Gore, Livingston, Scotland) is anastomosed to the ascending aorta by applying an aortic side clamp and 4/0 polypropylene running sutures, in the expectation of a potential upgrade to long-term mechanical circulatory support (HeartWare) and better flow distribution compared to direct cannulation, without the risk of incorrect placement in the supraaortic vessels. The tunnelled arterial line is coupled via a tube connector (*) to the vascular graft after complete deairing, and secured with cable ties. The right atrium (RA) is cannulated for venous return with a tunnelled 28F venous cannula of adjustable conformation (Medtronic, Minneapolis, MN, USA). A tunnelled 24F venting cannula (Medtronic) is implanted through the right superior pulmonary vein into the left ventricle (LV), warranting complete left ventricular decompression, and connected to the extracorporeal life support inflow (venous drainage) using a Y-connector. After meticulous deairing confirmed by transesophageal echocardiography, the central extracorporeal life support is set at full flow. Arrows indicate the direction of blood flow.
Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK Corresponding author: Alexander Weymann, MD, Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Hill End Road, Harefield, Middlesex UB9 6JH, UK. Email: [email protected]
Downloaded from aan.sagepub.com at University of Otago Library on June 4, 2016
