Infant Paracorporeal Lung Assist Device As Bridge To Lung Transplant
Timothy S. Lancaster, MD, Jacob R. Miller, MD, Rachel Lee, BA, Aaron M. Abarbanell, MD, Dilip S. Nath, MD, Pirooz Eghtesady, MD, PhD.
Washington University in St. Louis, St. Louis, MO, USA.
Objective: Children with end-stage lung disease who develop respiratory failure while awaiting lung transplantation have limited options, as transplant outcomes are poor when bridged with traditional venoarterial or venovenous extracorporeal support. We have employed a pumpless membrane oxygenation circuit as a paracorporeal lung assist device (PLAD) to successfully bridge several infants and small children to lung transplantation or recovery. Case Video Summary: We present the case of a 6 month old child with severe bronchopulmonary dysplasia and cystic lung disease who had persistent hypoxemia and hypercarbia despite maximal support with conventional mechanical ventilation. Preoperative imaging demonstrated extreme bilateral lung hyperinflation and suitable anatomy for placement of cannulae on the pulmonary artery (PA) and left atrium (LA). After careful median sternotomy to avoid lung injury, subcutaneous tunnels for two 6 mm Berlin Heart arterial cannulae are created. Bicaval and aortic cannulation is performed for cardiopulmonary bypass (CPB). One cannula is anastomosed to the anterior main PA using a pericardial buttress. After cardioplegic arrest, the second cannula is anastomosed to the LA below the right interatrial groove. The patient is transitioned from CPB to PLAD support. Conclusions: This patient was supported with the PLAD device for 32 days before undergoing successful en bloc bilateral lung transplant. We have demonstrated that the pumpless PLAD circuit can provide respiratory support for infants and small children awaiting lung transplant, while allowing for RV unloading, improved physical rehabilitation, and potential extubation. Operative details and technical considerations are shared here.
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