Our Summary

This research paper explores the use of a treatment known as venoarterial extracorporeal membrane oxygenation (VA-ECMO) in patients who have undergone a specific heart surgery (pericardiectomy) and are experiencing a harmful condition called low cardiac output syndrome (LCOS). This condition means that the heart is not pumping enough blood to meet the body’s needs. The study looks at nine cases from China and a selection of previous research articles.

The nine patients had all undergone heart surgery and then started VA-ECMO treatment after showing signs of LCOS. The results were positive: all patients survived and were discharged with good neurological health after being supported by ECMO for several days. A follow-up found that seven of these patients were still alive after an average of 56 months.

The additional review of past studies found mixed results. A study involving 69 patients reported a high mortality rate (63%) for those who received ECMO during or after surgery. However, four individual case reports showed all patients surviving after being discharged from hospital.

In summary, the study suggests that VA-ECMO could be an effective treatment for patients with LCOS after heart surgery, potentially improving survival rates. However, the researchers emphasize the need for more studies on this topic, as the current evidence is limited.

FAQs

  1. What is venoarterial extracorporeal membrane oxygenation (VA-ECMO) and why is it used in patients with low cardiac output syndrome (LCOS)?
  2. What were the results of the study that involved nine patients from China who had undergone a heart surgery and then started VA-ECMO treatment?
  3. What does the research suggest about the effectiveness of VA-ECMO treatment for patients with LCOS after heart surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about pericardiectomy is to closely follow post-operative care instructions, including taking medications as prescribed, attending follow-up appointments, and monitoring for any signs of complications such as chest pain, shortness of breath, or swelling. It is also important to maintain a healthy lifestyle, including regular exercise and a balanced diet, to support recovery and overall heart health. Additionally, patients should communicate any concerns or changes in symptoms to their healthcare provider promptly.

Suitable For

Pericardiectomy is a surgical procedure in which a portion or all of the pericardium, the sac surrounding the heart, is removed. Patients who may be recommended for pericardiectomy include those with conditions such as constrictive pericarditis, chronic effusive pericarditis, or cardiac tamponade. These conditions can lead to symptoms such as shortness of breath, chest pain, and fluid buildup around the heart.

Patients who undergo pericardiectomy and subsequently develop complications such as LCOS may be considered for VA-ECMO treatment. LCOS is a serious condition that can lead to organ dysfunction and even death if not promptly treated. VA-ECMO provides temporary support to the heart and lungs, allowing the body time to recover and stabilize.

Overall, patients who are recommended for pericardiectomy and subsequently develop LCOS may benefit from VA-ECMO treatment as a means of supporting their heart function and improving their chances of survival. However, each patient’s case should be evaluated individually by a medical team to determine the most appropriate course of treatment.

Timeline

Before the pericardiectomy, the patient likely experienced symptoms such as chest pain, difficulty breathing, fatigue, and swelling in the legs. Diagnostic tests such as echocardiograms and MRI scans would have been conducted to confirm the diagnosis of constrictive pericarditis. The patient would have been monitored closely by their healthcare team and may have undergone medical management to control symptoms.

After the pericardiectomy, the patient would have undergone a recovery period in the hospital, where they would be closely monitored for any complications such as bleeding, infection, or arrhythmias. Rehabilitation may have been recommended to help regain strength and mobility. In cases where the patient develops LCOS, VA-ECMO treatment may be initiated to support the heart and improve blood flow. The patient would continue to be monitored closely during ECMO support and would gradually be weaned off the treatment once their heart function improves.

Overall, the timeline for a patient before and after pericardiectomy involves initial symptoms, diagnosis, surgery, recovery, and potential complications such as LCOS requiring ECMO support. Close monitoring and appropriate medical interventions are essential for a successful outcome in these patients.

What to Ask Your Doctor

Some questions a patient should ask their doctor about pericardiectomy and the use of VA-ECMO for LCOS include:

  1. What is pericardiectomy and why is it necessary for my condition?
  2. What is low cardiac output syndrome (LCOS) and how does it affect my recovery after pericardiectomy?
  3. What is venoarterial extracorporeal membrane oxygenation (VA-ECMO) and how does it work in treating LCOS?
  4. What are the risks and potential complications of using VA-ECMO after pericardiectomy?
  5. How long will I need to be on VA-ECMO after my surgery?
  6. What is the success rate of VA-ECMO in patients with LCOS following pericardiectomy?
  7. Are there any alternative treatment options available for managing LCOS?
  8. What is the expected recovery time and long-term outlook for patients who undergo VA-ECMO after pericardiectomy?
  9. Are there any lifestyle changes or follow-up care that I should be aware of after receiving VA-ECMO treatment?
  10. Are there any ongoing clinical trials or research studies investigating the use of VA-ECMO in patients with LCOS following pericardiectomy?

Reference

Authors: Jia B, Yan S, Luo Y, Cheng J, Cheng J, Fei J, Gao Y, Liao X, Bian L, Wang J, Teng Y, Liu G, Gao L, Ji B. Journal: BMC Anesthesiol. 2025 Mar 1;25(1):110. doi: 10.1186/s12871-025-02977-4. PMID: 40025418