• Marta Kelava, Marijan Koprivanac, Nicholas Smedira, Tomislav Mihaljevic, and Andrej Alfirevic.
• Department of Cardiothoracic Anesthesiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH. Electronic address: kelavam@ccf.org.
• J. Cardiothorac. Vasc. Anesth. 2019 Jan 1; 33 (1): 60-69.

ObjectivesTo investigate short-term outcomes in patients with chronic thromboembolic pulmonary hypertension (CTEPH) presenting for pulmonary endarterectomy (PEA) and requiring extracorporeal membrane oxygenation (ECMO) during the perioperative period.DesignRetrospective observational case series involving patients who underwent PEA for CTEPH, with focus on a subpopulation requiring perioperative ECMO support.SettingSingle academic tertiary center.ParticipantsPatients who underwent PEA for CTEPH between January 1997 and December 2015 and required ECMO support.InterventionsPEA for CTEPH with ECMO support at any time during the perioperative period.Measurements And Main ResultsA total of 150 patients underwent PEA for CEPTH during the study period. Of the 150 patients, 14 (9.3%) required ECMO support and (43%) survived, were discharged, and were alive at the time of the review. A total of 8 (57%) ECMO patients died during hospitalization. Although indications and type of support changed in some patients during their hospital course, the majority of patients required venovenous ECMO support for hypoxia (N = 9) versus venoarterial ECMO for hemodynamic support (N = 5) as initial indication. The mean length of stay among survivors was 42.2 ± 22 days. Severe RV dysfunction was present preoperatively among 6 patients in the nonsurvivors group (75%) and 2 in the survivors group (33%). The overall mean duration of ECMO support was 7.3 ± 5.3 days (8.3 ± 7.3 days among survivors and 6.5 ± 3.5 days among nonsurvivors). Four patients died while on ECMO.ConclusionsAlthough still associated with high morbidity and mortality, ECMO appears to be an important treatment adjunct providing additional time for healing and recovery of cardiopulmonary function in patients who develop severe hypoxemia or right ventricular failure after PEA.Copyright © 2018 Elsevier Inc. All rights reserved.

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